目的 对三甲医院和社区常规保健幼儿进行孤独症谱系障碍筛查,探讨两者在接诊流程及结局上的差异,为今后开展筛查工作提供线索。方法 7 381名16~30月龄的儿童参与了孤独症谱系障碍筛查,其中三甲医院4 930人,社区2 451人。采用1∶1倾向评分匹配方法得到一般信息均衡的2 451对儿童,比较三甲医院和社区的筛查及诊断结果。结果 匹配后,三甲医院的初筛阳性率(17.7%)及后续访谈阳性率(42.5%)均高于社区(8.2%和2.8%)(P＜0.001);诊断失访率(11.7%)显著低于社区(47.0%)(P＜0.001)。两组样本的后续访谈失访率接近(49.2% vs 47.0%)(P=0.611)。结论 三甲医院和社区的筛查假阳性率均偏高,仍需提高应答准确率及重视后续访谈。相比三甲医院,社区失访儿童更容易面临延误诊疗的风险,建立主动监测、转诊及随访体系有助于促进基层医疗机构的早期筛查和诊断。
Abstract
Objective To compare the screening results for autism spectrum disorder (ASD) between Grade Ⅲ level A hospitals and community health services,and to provide clues for future screening work. Methods A total of 7 381 toddlers aged 16~30 months were involved in the ASD screening,including 4 930 toddlers from Grade Ⅲ level A hospitals and 2 451 from communities.By using propensity score matching (PSM) method,2 451 pairs of toddlers with comparable basic information were used to compare the screening results between Grade Ⅲ level A hospitals and communities. Results The positive rate of Grade Ⅲ level A hospitals (17.7%) was higher than that of the communities (8.2%).The positive rate of follow-up interview(42.5%) was also higher than that of the communities (2.8%)(P<0.001).But the lost rate of diagnosis (11.7%) was lower than that in the communities (47.0%) (P＜0.001).The lost rates of follow-up interview in two kinds of samples were close(49.2% vs 47.0%,P=0.611). Conclusions The false positive rate in both Grade Ⅲ level A hospitals and communities is so high that the accuracy should be improved and follow-up interview should be taken seriously.Those failed to be followed up in communities are more likely to increase the risk of delayed diagnosis and treatment.An active monitoring,referral and follow-up system may help to improve early screening and diagnosis in primary health care services.
关键词
孤独症谱系障碍 /
早期筛查 /
三甲医院 /
社区
Key words
autism spectrum disorder /
early screening /
Grade Ⅲ level A hospital /
community
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