title: Primary Care Providers' Initial Evaluation of Children with Global Developmental Delay: A Clinical Vignette Study.
abstract: OBJECTIVE
  To examine the decisions of pediatric primary care physicians about their diagnostic evaluation for a child with suspected global developmental delay (GDD).
  
  
  METHODS
  A survey was mailed to a sample of pediatricians (n = 600) and family physicians (n = 600) randomly selected from the American Medical Association Physician Masterfile. The survey contained a clinical vignette describing a 9-month-old nondysmorphic boy with GDD. Participants were asked their initial evaluation steps (test, refer, or both test and refer) and what types of referral and/or testing they would pursue. We examined bivariate associations between physician/clinical practice characteristics and participants' evaluation decision.
  
  
  RESULTS
  More pediatricians than family physicians completed the survey (response rates: 55% vs 38%). Almost three-quarters of the respondents (74%) reported that their first step in a diagnostic evaluation would be to refer the child without testing, 22% would test only, and 4% would both test and refer. As their initial step, most physicians referred to a developmental pediatrician (58%), and only 5% would refer to a geneticist. The most commonly ordered test was general biochemical testing (64%). The most commonly ordered genetic test was a karyotype (39%).
  
  
  CONCLUSIONS
  When evaluating a child with GDD, few primary care physicians would order genetic testing or refer to a genetics specialist as a first evaluation step. Future studies should examine both barriers to and utilization of a genetic evaluation for children with GDD.
authors.affiliation: Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI. Electronic address: btarini@umich.edu.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Tarini
authors.affiliation: Department of Health Behavior and Health Education and Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Zikmund-Fisher
authors.affiliation: Division of Human Genetics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Howard M
authors.initials: HM
authors.lastname: Saal
authors.affiliation: Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
authors.forename: Laurie
authors.initials: L
authors.lastname: Edmondson
authors.affiliation: Department of Internal Medicine and Department of Human Genetics, University of Michigan, Ann Arbor, MI.
authors.forename: Wendy R
authors.initials: WR
authors.lastname: Uhlmann
mesh_terms: D002658:Developmental Disabilities / Q000175:diagnosis*; D003952:Diagnostic Imaging; D005260:Female; D005820:Genetic Testing; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*; D014481:United States