title: Predicting developmental delay in a longitudinal cohort of preschool children with single-suture craniosynostosis: is neurobehavioral assessment important?
abstract: OBJECTIVE
  The aim of this study was to determine whether neurobehavioral assessment before and after cranial vault surgery can improve prediction of developmental delay in children with single-suture craniosynostosis (SSC), after accounting for 'baseline' demographic and clinical variables (SSC diagnosis and surgery age).
  
  
  METHODS
  Children with SSC were referred by the treating surgeon or pediatrician before surgery. Neurobehavioral assessments were performed at ages of approximately 6, 18, and 36 months. Iterative models were developed to predict delay, as determined by one or more tests of cognitive, motor, and language skills at 36 months. We selected from groups of variables entered in order of timing (before or after corrective surgery), and source of information (parent questionnaire or psychometric testing).
  
  
  RESULTS
  Good predictive accuracy as determined by area under the receiver operating characteristic curve (AUC), was obtained with the baseline model (AUC=0.66), which incorporated age at surgery, sex, and socio-economic status. However, predictive accuracy was improved by including pre- and post-surgery neurobehavioral assessments. Models incorporating post-surgery neurobehavioral testing (AUC=0.79), pre-surgery testing (AUC=0.74), or both pre- and post-surgery testing (AUC=0.79) performed similarly. However, the specifity of all models was considered to be moderate (≤0.62).
  
  
  CONCLUSIONS
  Prediction of delay was enhanced by assessment of neurobehavioral status. Findings provide tentative support for guidelines of care that call for routine testing of children with SSC.
authors.affiliation: Department of Health Services, University of Washington, Seattle, WA, USA.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Gray
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Kapp-Simon
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Starr
authors.forename: Brent R
authors.initials: BR
authors.lastname: Collett
authors.forename: Erin R
authors.initials: ER
authors.lastname: Wallace
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Speltz
mesh_terms: D002675:Child, Preschool; D003393:Cranial Sutures / Q000473:pathology; D003398:Craniosynostoses / Q000150:complications* / Q000601:surgery; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008959:Models, Neurological; D011379:Prognosis