INCLEN Diagnostic Tool for Neuromotor Impairments (INDT-NMI) for primary care physician: Development and validation

• Published in: Indian pediatrics 2014-08, Vol.51 (8), p.613-619
• Main Authors: Gulati, Sheffali, Aneja, Satinder, Juneja, Monica, Mukherjee, Sharmila, Deshmukh, Vaishali, Silberberg, Donald, Bhutani, Vinod K., Pinto, Jennifer M., Durkin, Maureen, Tudu, Poma, Pandey, Ravindra M., Nair, M. K. C., Arora, Narendra K.
• Format: Article
• Language: English
• Subjects: Algorithms; Cerebral Palsy - diagnosis; Child; Child, Preschool; Developmental Disabilities - diagnosis; Female; Humans; India; Male; Maternal and Child Health; Medicine; Medicine & Public Health; Neuromuscular Diseases - diagnosis; Pediatric Surgery; Pediatrics; Pediatrics - methods; Physicians, Primary Care; Research Paper; Sensitivity and Specificity
• ISSN: 0019-6061; 0974-7559
• DOI: 10.1007/s13312-014-0463-3

Objectives To develop and validate a diagnostic tool for use by primary care physicians for diagnosing neuro-motor impairment among 2–9 year old children in primary care settings. Study design Modified Delphi technique involving national ( n =49) and international ( n =6) experts was used for development of INDT-NMI. The tool was then validated through a cross sectional study. Setting Neurology specialty clinics of three tertiary care pediatric centers in New Delhi, India. Participants 454 children aged 2–9 years [mean (SD) age: 60.4 (23.7) mo], selected through systematic random sampling, underwent assessment for identification and classification of neuromotor impairments (NMI). Intervention All study subjects were first administered INDT-NMI (candidate test) by a trained physician followed by expert assessment for NMI and other neurodevelopment disorders (NDD) by team of two pediatric neurologists (Gold standard). Results According to expert evaluation, 171 (37.8%) children had neuromotor impairments. There were four categories of subjects: NMI alone ( n =66); NMI+other NDDs ( n =105); Other NDDs without NMI ( n =225) and ‘Normal’ group ( n =58). Using expert evaluation as gold standard, overall sensitivity of the INDT-NMI was 75.4% and specificity was 86.8%. INDT-NMI helped graduate physicians to correctly classify 86.6% (112/129) children with NMI into different types (cerebral palsy, neuromotor diseases and other NMI). Graduate physicians assigned 40 children (8.8%) as ‘indeterminate’, 38 (95%) of whom had either NDD and/or NMI and thus merited referral. Misclassification of NMI occurred in those with mild changes in muscle tone, dystonia, or ataxia and associated NDDs. Conclusion Graduate primary care physicians with a structured short training can administer the new tool and diagnose NMI in 2–9 year old children with high validity. INDT-NMI requires further evaluation in actual primary care settings.