Symptom reporting in childhood asthma: a comparison of assessment methods
Symptom reporting in childhood asthma: a comparison of assessment methods
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DOI：
10.1136/adc.2006.096123
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发表时间：
2006-09-01
影响因子：
5.2
通讯作者：
McMullen, A.
中科院分区：
文献类型：
--
作者：
Halterman, J. S.;Yoos, H. L.;McMullen, A.
背景：接受充分哮喘治疗的一个障碍是对症状严重程度的不准确估计。目的：访谈哮喘儿童的父母，以便：（1）使用三种非结构化评估方法描述报告的疾病严重程度的范围;（2）确定哪种评估方法最不可能导致可能对儿童护理产生不利影响的“关键错误”;（3）确定是否可能因社会人口特征而发生“关键错误”。共有228名哮喘儿童的父母参加了研究。使用反映国家哮喘教育和预防小组（NAEPP）标准的结构化问题评估临床状态。使用视觉模拟量表（VAS）、严重程度分类评估和哮喘控制的Likert量表评估来确定严重程度的非结构化评估。一个“关键错误”被定义为家长报告的症状在较低的第50百分位数的每一种方法的评估为儿童与中度严重的持续性症状NAEPP criteria.Results：儿童与较高的严重程度根据NAEPP标准被评为对每个非结构化的评估为更多的症状相比，那些不太严重的症状。然而，在中重度持续症状的儿童中，许多父母犯了一个严重的错误，使用VAS（41%）、分类评估（45%）和对照评估（67%）将儿童评定为第50百分位数以下。父母犯下重大错误的可能性并没有改变sociodemographic characteristics.Conclusions：所有的非结构化评估方法测试产生低估的严重程度，可能会产生不利影响的治疗决策。为了准确评估严重程度，需要提出具体的症状问题。
Background: One barrier to receiving adequate asthma care is inaccurate estimations of symptom severity. Aims: To interview parents of children with asthma in order to: ( 1) describe the range of reported illness severity using three unstructured methods of assessment; (2) determine which assessment method is least likely to result in a "critical error'' that could adversely influence the child's care; and (3) determine whether the likelihood of making a "critical error'' varies by sociodemographic characteristics.Methods: A total of 228 parents of children with asthma participated. Clinical status was evaluated using structured questions reflecting National Asthma Education and Prevention Panel (NAEPP) criteria. Unstructured assessments of severity were determined using a visual analogue scale ( VAS), a categorical assessment of severity, and a Likert scale assessment of asthma control. A "critical error'' was defined as a parent report of symptoms in the lower 50th centile for each method of assessment for children withmoderate-severe persistent symptoms by NAEPP criteria.Results: Children with higher severity according to NAEPP criteria were rated on each unstructured assessment as more symptomatic compared to those with less severe symptoms. However, among the children with moderate-severe persistent symptoms, many parents made a critical error and rated children in the lower 50th centile using the VAS (41%), the categorical assessment (45%), and the control assessment (67%). The likelihood of parents making a critical error did not vary by sociodemographic characteristics.Conclusions: All of the unstructured assessment methods tested yielded underestimations of severity that could adversely influence treatment decisions. Specific symptom questions are needed for accurate severity assessments.