Symptom reporting in childhood asthma: A comparison of assessment methods

Jill Suzanne Halterman ^1*, H. Lorrie Yoos ², Harriet Kitzman ², Elizabeth Anson ², Kimberly Sidora-Arcoleo ² and Ann McMullen ²

¹ University of Rochester, United States
² University of Rochester School of Nursing, United States

^* To whom correspondence should be addressed. E-mail: jill_halterman{at}urmc.rochester.edu.

Accepted 7 May 2006

Abstract

Background: One barrier to receiving adequate asthma care is inaccurate estimations of symptom severity.

Objective: 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; 3) Determine whether the likelihood of making a "critical error" varies by socio-demographic characteristics.

Methods: 228 parents of children with asthma participated. We evaluated clinical status using structured questions reflecting National Asthma Education and Prevention Panel (NAEPP) criteria. Unstructured assessments of severity were determined using a visual analog scale (VAS), a categorical assessment of severity, and a likert-scale assessment of asthma control. We defined a "critical error" as a parent report of symptoms in the lower 50th percentile for each method of assessment for children with moderate- severe persistent symptoms by NAEPP criteria.

Results: We found that 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 percentile 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 socio-demographic 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.

Keywords: childhood asthma, parent assessments, preventive care, symptoms

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Howard Bauchner
Arch. Dis. Child. 2006 91: 721. [Extract] [Full Text] [PDF]

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