Prompt referral for diagnosis of cerebral palsy: from current‐practices to best‐practices

the typically developing population. Risk assessment is a proactive, cost-effective strategy for identifying vulnerable individuals. The aim of this study was to validate the Choking Risk Assessment (CRA) and the Pneumonia Risk Assessment (PRA), two tests developed to predict individual vulnerability for occurrences of choking and pneumonia. The long-term goal of this work is to reduce negative outcomes associated with choking and pneumonia by allocation of risk-preventative resources to those individuals with higher probability of occurrence. Study Design: Retrospective cohort study. Study Participants & Setting: A total of 619 adults diagnosed with severe or profound IDD provided the cohort for validating the CRA. Additionally, 272 of the individuals participated in the validation of the PRA. All individuals had resided in two group settings for a minimum of five years and were a minimum of 25-years old. The study groups formed were Positive Choking Group (PCG), n=93, 15.02%; Negative Choking Group (NCG), n=526; Positive Pneumonia Group (PPG), n=45, 16.5%; and Negative Pneumonia Group (NPG), n=227. Materials/Methods: This was a three phase study. Phase 1. Test items for the CRA and PRA were identified through literature review and focus groups discussion. Phase 2. Blinded, 5-year, retrospective chart reviews identified participants who had experienced non-fatal choking episodes (NFCE) requiring assistance for rescue and those who had experienced non-fatal pneumonia episodes (NFPE). Phase 3. The CRA and PRA were administered to their respective study groups. Clinical diagnosis of dysphagia was made using the Dysphagia Disorder Survey and the Dysphagia Management Staging Scale, assessments standardized for children and adults with IDD. The psychometric properties of the CRA and PRA were determined by comparing the results for the PCG and the NCG and the PPG and the NPG. Data were subjected to statistical assessments for reliability and validity using Cronbach’s Coefficient Alpha, bivariate analysis and logistic regression. Results: The CRA and PRA contained ten items each, nine predictor variables plus occurrence of the risk event. Internal consistency for the CRA was a=0.65 and for the PRA a=0.73. Overall CRA and PRA items were related to choking and pneumonia respectively at p≤0.001. At a score of two of ten items, the CRA correctly predicted 85.8% of the sample, while the PRA correctly predicted 76.8% of the sample. The same cutoff score identified 92% of the NFCE and 86.5% of the NFPE. The assessments discriminated the PCG from the NCG and the PPG from the NPG with specificity of 0.91 and 0.92 and sensitivity of 0.53 and 0.62, respectively. Further analysis revealed significant associations between clinical diagnosis of dysphagia and choking (p=0.043) and clinical diagnosis of dysphagia and pneumonia (p<0.001). Absence of dysphagia reduced likelihood of pneumonia by 81% and likelihood of choking by almost 50%. Conclusions/Significance: These assessments demonstrated high specificity for identifying risk for choking and/or pneumonia in adults with IDD thus providing criteria for intervening selectively to mitigate risk. SP 63 Prompt referral for diagnosis of cerebral palsy: from current-practices to best-practices Z BOYCHUCK, J ANDERSEN, A BUSSI ERES, D FEHLINGS, A KIRTON, M OSKOUI, C RODRIGUEZ, M SHEVELL, L SNIDER, A MAJNEMER McGill University, Montreal Children’s Hospital-McGill University Health Centre, McGill University Health Centre Research Institute, Centre for Interdisciplinary Research in Rehabilitation, Montreal, PQ, Canada; University of Alberta, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada; McGill University, Universit e du Qu ebec a Trois-Rivi eres, Montreal, PQ, Canada; University of Toronto, Holland-Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada; University of Calgary, Alberta Children’s Hospital, Calgary, AB, Canada; Research Institute-McGill University Health Centre, Montreal Children’s Hospital-McGill University Health Centre, McGill University, Montreal, PQ, Canada; McGill University, Montreal, PQ, Canada; Montreal Children’s Hospital-McGill University Health Centre, McGill University, Montreal, PQ, Canada; McGill University, Research Institute of the McGill University Health Centre, Montreal, PQ, Canada