Schmidt Silke, Thyen Ute, Petersen Corinna, Bullinger Monika
Institute and Clinic of Medical Psychology, Centre for Psychosocial Medicine S35, University Hospital of Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Eur J Pediatr. 2004 Sep;163(9):517-23. doi: 10.1007/s00431-004-1458-1. Epub 2004 Jun 15.
In the field of paediatric health care, measures based on consequences of health conditions have been recently developed to screen for children with special health care needs. These tools have been primarily used in survey research. The aim of this cross-sectional clinical study is to test the performance of a screener for identifying children with special health care needs (CSHCN) in a population of children with chronic conditions diagnosed and treated in different European paediatric hospitals. In the current study, the screener was employed in a sample of children with different chronic conditions (asthma, arthritis, dermatitis, epilepsy, cystic fibrosis, diabetes and cerebral palsy) across seven European countries; 456 parents of children, aged 4-7, 8-12, and 13-16 years, responded to the screener items. The study included a range of clinical measures to assess the severity of the conditions as well measures on functional health status. The prevalence of children identified positively with the CSHCN screener was 80%, which was higher than in survey estimates in the United States. Considerable variation in the screener classification was found between chronic conditions with cystic fibrosis and epilepsy showing higher rates, and skin conditions lower rates. There was no significant relationship between the screener classification and functional limitation. Findings of this study support in general the validity of the children with special health care needs screener, which shows, however, a differential validity across specific conditions. Several clinical and theoretical explanations for the lack of identifying some children with chronic conditions and the considerable variation between the conditions are discussed.
在儿科医疗保健领域，最近已开发出基于健康状况后果的措施，以筛查有特殊医疗保健需求的儿童。这些工具主要用于调查研究。这项横断面临床研究的目的是测试一种筛查工具在不同欧洲儿科医院诊断和治疗的慢性病患儿群体中识别有特殊医疗保健需求儿童（CSHCN）的性能。在当前研究中，该筛查工具应用于来自七个欧洲国家的患有不同慢性病（哮喘、关节炎、皮炎、癫痫、囊性纤维化、糖尿病和脑瘫）的儿童样本；456名年龄在4至7岁、8至12岁和13至16岁儿童的家长对筛查项目做出了回应。该研究包括一系列评估病情严重程度的临床措施以及功能健康状况的测量。被CSHCN筛查工具阳性识别的儿童患病率为80%，高于美国的调查估计值。在慢性病中，囊性纤维化和癫痫的筛查分类率较高，而皮肤病的筛查分类率较低，两者之间存在相当大的差异。筛查分类与功能受限之间没有显著关系。本研究结果总体上支持有特殊医疗保健需求儿童筛查工具的有效性，然而，该工具在特定病情中显示出不同的有效性。文中讨论了未能识别一些慢性病患儿以及不同病情之间存在显著差异的一些临床和理论解释。
