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The Predictive Accuracy of the General Movement Assessment for Cerebral Palsy: A Prospective, Observational Study of High-Risk Infants in a Clinical Follow-Up Setting
Open AccessFeature PaperArticle

The Pooled Diagnostic Accuracy of Neuroimaging, General Movements, and Neurological Examination for Diagnosing Cerebral Palsy Early in High-Risk Infants: A Case Control Study

1
Cerebral Palsy Alliance Research Institute, Child and Adolescent Health, The University of Sydney, Sydney, NSW 2050, Australia
2
Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 56128 Rome, Italy
3
Department of Developmental Neuroscience, Stella Maris Scientific Institute, 00168 Pisa, Italy
4
Grace Centre for Newborn Care, Children’s Hospital at Westmead, Sydney, NSW 2145, Australia
5
Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(11), 1879; https://doi.org/10.3390/jcm8111879
Received: 31 August 2019 / Revised: 23 October 2019 / Accepted: 24 October 2019 / Published: 5 November 2019
Introduction: Clinical guidelines recommend using neuroimaging, Prechtls’ General Movements Assessment (GMA), and Hammersmith Infant Neurological Examination (HINE) to diagnose cerebral palsy (CP) in infancy. Previous studies provided excellent sensitivity and specificity for each test in isolation, but no study has examined the pooled predictive power for early diagnosis. Methods: We performed a retrospective case-control study of 441 high-risk infants born between 2003 and 2014, from three Italian hospitals. Infants with either a normal outcome, mild disability, or CP at two years, were matched for birth year, gender, and gestational age. Three-month HINE, GMA, and neuroimaging were retrieved from medical records. Logistic regression was conducted with log-likelihood and used to determine the model fit and Area Under the Curve (AUC) for accuracy. Results: Sensitivity and specificity for detecting CP were 88% and 62% for three-month HINE, 95% and 97% for absent fidgety GMs, and 79% and 99% for neuroimaging. The combined predictive power of all three assessments gave sensitivity and specificity values of 97.86% and 99.22% (PPV 98.56%, NPV 98.84%). Conclusion: CP can be accurately detected in high-risk infants when these test findings triangulate. Clinical implementation of these tools is likely to reduce the average age when CP is diagnosed, and intervention is started. View Full-Text
Keywords: cerebral palsy; diagnostic accuracy; general movements; HINE cerebral palsy; diagnostic accuracy; general movements; HINE
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Morgan, C.; Romeo, D.M.; Chorna, O.; Novak, I.; Galea, C.; Del Secco, S.; Guzzetta, A. The Pooled Diagnostic Accuracy of Neuroimaging, General Movements, and Neurological Examination for Diagnosing Cerebral Palsy Early in High-Risk Infants: A Case Control Study. J. Clin. Med. 2019, 8, 1879.

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