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Letter
Investigating early developmental impairment: what's the cost?
  1. Anthony R Hart,
  2. Daniel JA Connolly,
  3. Ruchi Sharma
  1. Department of Paediatric Neuroradiology, Sheffield Children's Hospital NHS Foundation Trust, Ryegate Children's Centre, Sheffield, UK
  1. Correspondence to Dr Anthony R Hart, Department of Paediatric Neurology, Sheffield Children's Hospital NHS Foundation Trust, Ryegate Children's Centre, Tapton Crescent Road, Sheffield S10 5DD, UK; anthony.hart{at}sch.nhs.uk

https://doi.org/10.1136/archdischild-2017-313532

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    Considerable resources are spent on determining the cause of early developmental impairment (EDI) in children, yet the most appropriate investigations are unknown. Significant differences in opinion exist between UK clinicians on whether children with EDI are investigated appropriately and on the value of specific investigations.1 Algorithms on how to investigate EDI have been proposed over the last 20 years, and the number of recommended first-line laboratory investigations has increased,2–4 without good evidence on their usefulness or cost efficiency. We obtained guidelines for investigating EDI from 23 centres as part of a survey of UK clinicians1 and found variation in recommended investigations, with only karyotype/microarray being consistent across all guidelines (figure 1).

    Figure 1

    Investigations recommended in 23 guidelines obtained from UK clinicians. Columns represent individual guidelines, and rows individual investigations. Grey boxes represent a first-line investigation to be performed in all children with early developmental …

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    Footnotes

    • Contributors ARH: designed/conceived the idea for our initial survey and collated the guidelines we were sent as part of that study. ARH reviewed the data on the investigations performed in our centre and calculated cost, he wrote majority of the letter. RC, DJAC: significantly contributed to revising project design and the contents of the article. They made suggestions on data interpretation and the articles contents. All authors reviewed drafts of the paper and agreed on the final version. All authors are accountable for the integrity and accuracy of the data submitted.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data sharing statement A number of questions we asked as part of our UK survey (from which we obtained the guidelines) are not reported because they were poorly phrased and did not reveal useful information. The data are available on request from the corresponding author.

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