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Table 6 Summary of evidence and recommendations for screening interventions

From: Supporting recommendations for childhood preventive interventions for primary health care: elaboration of evidence synthesis and lessons learnt

  Evidence     Recommendations  
Screening interventions Accuracy of screening tests (certainty of the evidencea) Effectiveness of treatment (certainty of the evidencea) Potential harms (certainty of the evidencea) Benefits of screening: early detection for early intervention (certainty of the evidencea) Recommendations across reviewed documents Strength of recommen-dationsa
Vision screening
 Newborn and small infants: ocular inspection and red reflex Low sensitivity High Harmless examination Essential Recommended (PrevInfad, CDC, NICE, RCPCH) Not graded
 Children 6–59 months: screening amblyopia and its risk factors Accurate tools for detecting amblyopia and risk factors (low certainty of the evidence) Overall effective Some psychological harms related with patching (uncertainty of the evidence) Indirect evidence of moderate net benefit (moderate certainty of evidence) - In < 3 years: insufficient evidence (USPSTF, PrevInfad, CDC)
- In 3 to 5 years: screening recommended (USPSTF, PrevInfad, CDC, AAP, RCPCH, UK NSC)
I statement
B recommen-dation
Pulse oximetry for detecting CCHD
 Use of pulse oximetry for detecting CCHD SR (16 prospective and 5 retrospective studies): for a threshold of < 95% for positivity: sensitivity 76.3% (low certainty evidence); specificity 99.9% (high certainty evidence) Effective Safe and harmless tool
Unnecessary investigations (not invasive), potentially admissions and familiar anxiety for false positive cases
Overall beneficial - Screening recommended by AEP (Level A evidence), CDC, AAP
- Insufficient evidence to recommend screening according to RCPCH, UK NSC
Not available
 Timing of pulse oximetry for detecting CCHD - Early < 24 h (SR, 8 studies): sensitivity 79.5% and specificity 99.6%.
- Late > 24 h (SR, 11 studies): sensitivity 73.6% and specificity 99.9%.
- False positive rate significantly lower among newborns screened > 24 h (0.06% versus 0.42%; P = 0.027)
Early diagnosis leads to timeliness of treatment.
Early screening leads to higher false positive rates. But most false positive cases are indicative of other severe disorders that may also require prompt diagnosis and treatment.
- Early screening (<  24 h) recommended by AEP (Level B evidence)
- Late screening (>  24 h) recommended by CDC, AAP
Not available
Universal screening for detecting IDA
 IDA screening No suitable test for IDA screening that is non-invasive with high accuracy for detecting IDA Lack of evidence on the effects of treatment of IDA for improving growth, cognitive and psychomotor development outcomes Lack of evidence that evaluate harms of overall screening.
Adverse effects associated with oral iron: no differences found between children receiving iron and placebo.
Lack of evidence - Recommendation against screening by PrevInfad, the UK NSC, USPSTF
- Screening recommended by AAP
Strong recommen-dation (PrevInfad);
I statement (USPSTF)
Universal screening for detecting ASD
 In young children for whom no concerns of ASD have been raised Accurate tools Some evidence of benefit of early interventions applied to children with ASD identified due to developmental concerns.
No evidence on the effectiveness of interventions applied to children with ASD detected through screening.
Limited evidence assessing harms of screening or interventions for ASD.
Potential harms are likely to be small. However, interventions can be associated with important burden for the families in terms of time and resources.
Overall lack of evidence - Screening recommended by CDC, AAP
- Recommendation against universal screening by PrevInfad, UK NSC, Canadian Task Force on Preventive Healthcare
- Insufficient evidence to assess the balance of benefits and harms of screening for ASD by USPSTF
Weak recommen-dation (PrevInfad);
I statement (USPSTF)
Universal screening for detecting language and speech delay
 In young children for whom no concerns about their speech or language have been raised Wide variation in accuracy.
No single screening tool with best characteristics for screening.
Evidence that targeted interventions improve some measures of speech and language delay and disorders. However, there is no evidence on the effectiveness of such interventions in children detected by screening with no specific concerns about their speech or language prior to screening Burden for the families in terms of time, resources, anxiety.
No evidence on the harms of screening for language and speech delay in primary care settings
Limited evidence assessing potential harms of interventions.
Lack of evidence - Recommendation against universal screening by, UK NSC, Canadian Task Force on Preventive Healthcare
- Insufficient evidence to assess the balance of benefits and harms of screening for ASD by USPSTF
Strong recommen-dation (Canadian Task Force);
I statement (USPSTF)
  1. Abbreviations: AAP American Academy of Pediatrics, AEP Spanish Paediatric Association (Asociación Española de Pediatría), ASD Autistic spectrum disorder, CCHD Critical congenital heart defects, CDC Centers of Disease Control and Prevention, IDA Iron deficiency anaemia, NICE National Institute for Health and Care Excellence, RCPCH Royal College of Paediatrics and Child Health, SR Systematic review, UK NSC United Kingdom National Screening Committee, USPSTF United States Preventive Services Task Force
  2. aAs per the authors of the retrieved documents