Analysis of clinical features predicting etiologic yield in the assessment of global developmental delay

OBJECTIVE. Global developmental delay is a common reason for presentation for neurologic evaluation. This study examined the role of clinical features in predicting the identification of an underlying cause for a child's global developmental delay. METHODS. Over a 10-year inclusive interval, the case records of all consecutive children < 5 years of age referred to a single ambulatory practice setting for global developmental delay were systematically reviewed. The use of clinical features in predicting the identification of a specific underlying cause for a child's delay was tested using chi(2) analysis. RESULTS. A total of 261 patients eventually met criteria for study inclusion. Mean age at initial evaluation was 33.6 months. An underlying cause was found in 98 children. Commonest etiologic groupings were genetic syndrome/chromosomal abnormality, intrapartum asphyxia, cerebral dysgenesis, psychosocial deprivation, and toxin exposure. Factors associated with the ability to eventually identify an underlying cause included female gender ( 40 of 68 vs 58 of 193), abnormal prenatal/perinatal history ( 52 of 85 vs 46 of 176), absence of autistic features ( 85 of 159 vs 13 of 102), presence of microcephaly ( 26 of 40 vs 72 of 221), abnormal neurologic examination ( 52 of 71 vs 46 of 190), and dysmorphic features ( 44 of 84 vs 54 of 177). In 113 children without any abnormal features identified on history or physical examination, routine screening investigations ( karyotype, fragile X molecular genotyping, and neuroimaging) revealed an underlying etiology in 18. CONCLUSIONS. Etiologic yield in an unselected series of young children with global developmental delay is close to 40% overall and 55% in the absence of any coexisting autistic features. Clinical features are readily apparent that may enhance an expectation of a successful etiologic search. Screening investigations may yield an underlying cause.