Validating childhood asthma in an epidemiological study using linked electronic patient records.
Validating childhood asthma in an epidemiological study using linked electronic patient records.
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DOI：
10.1136/bmjopen-2014-005345
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发表时间：
2014-04-23
期刊：
影响因子：
2.9
通讯作者：
Macleod J
中科院分区：
文献类型：
--
作者：
Cornish RP;Henderson J;Boyd AW;Granell R;Van Staa T;Macleod J
研究父母报告的数据在识别经医生证实的哮喘中的表现。使用雅芳父母和儿童纵向研究（ALSPAC）和全科医学研究数据库（GPRD）中保存的电子病历之间的联系进行验证研究。参与者是那些有资格参加ALSPAC的人，他们也在GPRD中有记录;这包括765名个人，略低于ALSPAC合格参与者的4%。该分析基于141名具有完整的父母报告哮喘数据的参与者。GPRD的主要结果指标是儿童是否在9岁之前被诊断为哮喘。父母报告的指标是医生诊断的哮喘（平均年龄7.5岁之前），基于6个月至8.5岁之间纵向记录的喘息和呼吸困难的各种结局。 次要结局为支气管高反应性（BHR）、1秒用力呼气量/用力肺活量比值和皮肤点刺试验反应。 在141名有完整父母报告数据的参与者中，26名（18%）在9岁之前被诊断为哮喘。使用全科医生（GP）记录的哮喘作为金标准，问题是“医生是否诊断过您的孩子患有哮喘？”敏感性88.5%，特异性95.7%。“曾经喘息”的敏感性最高（100%），但特异性较低（60%）。更具体的定义是通过限制在那些有喘息不止一次，经历了频繁喘息和/或喘息后，3岁，但这些措施的敏感性低。BHR仅识别了50%的GP记录诊断的患者。父母对医生诊断的报告与GP记录的诊断一致。通过使用详细的喘息问题可以实现哮喘的高特异性，尽管这些定义可能会排除轻度哮喘病例。我们的研究表明，观察性研究和电子病历之间的联系有可能加强流行病学研究。
To investigate the performance of parent-reported data in identifying physician-confirmed asthma. Validation study using linkage between the Avon Longitudinal Study of Parents and Children (ALSPAC) and electronic patient records held within the General Practice Research Database (GPRD). Participants were those eligible to participate in ALSPAC who also had a record in the GPRD; this included 765 individuals, just under 4% of ALSPAC-eligible participants. The analysis was based on 141 participants with complete parent-reported asthma data. The main GPRD outcome measure was whether a child had a diagnosis of asthma before they were nine. Parent-reported measures were doctor diagnosis of asthma (before mean age 7.5 years), various outcomes based on wheezing and breathlessness recorded longitudinally between 6 months and 8.5 years. Secondary outcomes were bronchial hyper-responsiveness (BHR), forced expiratory volume in 1 s/forced vital capacity ratio and skin prick test responses. Among the 141 participants with complete parent-reported data, 26 (18%) had an asthma diagnosis before age nine. Using general practitioner (GP)-recorded asthma as the gold standard, the question ‘Has a doctor ever diagnosed your child with asthma?’ was both sensitive (88.5%) and specific (95.7%). ‘Ever wheezed’ had the highest sensitivity (100%) but low specificity (60%). More specific definitions were obtained by restricting to those who had wheezed on more than one occasion, experienced frequent wheeze and/or wheezed after the age of 3, but these measures had low sensitivities. BHR only identified 50% of those with a GP-recorded diagnosis. Parental reports of a doctor's diagnosis agree well with a GP-recorded diagnosis. High specificity for asthma can be achieved by using detailed wheezing questions, although these definitions are likely to exclude mild cases of asthma. Our study shows that linkage between observational studies and electronic patient records has the potential to enhance epidemiological research.
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作者：
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