Article

This systematic review evaluates the accuracy of predictive assessments and
investigations used to assist in the diagnosis of cerebral palsy (CP) in
preschool-age children (<5 y). METHOD: Six databases were searched for studies
that included a diagnosis of CP validated after 2 years of age. The validity of
the studies meeting the criteria was evaluated using the Standards for Reporting
Diagnostic Accuracy criteria. Where possible, results were pooled and a
meta-analysis was undertaken. RESULTS: Nineteen out of 351 studies met the full
inclusion criteria, including studies of general movements assessment (GMA),
cranial ultrasound, brain magnetic resonance imaging (MRI), and neurological
examination. All studies assessed high-risk populations including preterm
(gestational range 23-41 wks) and low-birthweight infants (range 500-4350 g).
Summary estimates of sensitivity and specificity of GMA were 98% (95% confidence
interval [CI] 74-100%) and 91% (95% CI 83-93%) respectively; of cranial
ultrasound 74% (95% CI 63-83%) and 92% (95% CI 81-96%) respectively; and of
neurological examination 88% (95% CI 55-97%) and 87% (95% CI 57-97%)
respectively. MRI performed at term corrected age (in preterm infants) appeared
to be a strong predictor of CP, with sensitivity ranging in individual studies
from 86 to 100% and specificity ranging from 89 to 97% There was inadequate
evidence for the use of other predictive tools. SUMMARY: This review found that
the assessment with the best evidence and strength for predictive accuracy is the
GMA. MRI has a good predictive value when performed at term-corrected age.
Cranial ultrasound is as specific as MRI and has the advantage of being readily
available at the bedside. Studies to date have focused on high-risk infants. The
accuracy of these tests in low-risk infants remains unclear and requires further
research.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2013 Mac Keith
Press.

Langue : ANGLAIS