Stone Kimberly E, Burrell Lori, Higman Susan M, McFarlane Elizabeth, Fuddy Loretta, Sia Calvin, Duggan Anne K
Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine, Baltimore, MD 21205, USA.
Ambul Pediatr. 2006 Mar-Apr;6(2):91-5. doi: 10.1016/j.ambp.2005.10.003.
To assess agreement of injury reporting between primary care medical record and maternal interview.
Cross-sectional study of data from a randomized controlled trial of home visiting. The setting was Hawaii's Healthy Start Program (HSP). Subjects comprised a population-based sample of children in at-risk families with 3 years of primary care medical records and maternal interviews (n = 443). Outcome measures were percentage of children injured unintentionally and mean number of injuries per child in the first 3 years of life by primary care medical record and maternal interview.
We identified 490 injuries: 48% by primary care medical record, 22% by maternal interview, and 30% in both sources. More children were reported injured by primary care medical record than maternal interview (51% vs 39%, P< .001). The mean number of injuries per child was 0.87 by primary care medical record and 0.51 by maternal interview (difference 0.36, 95% confidence interval 0.27-0.45, P< .001). Agreement between data sources was fair (kappa = 0.47).
This study estimates that 25% of childhood injuries may not be reported in the medical record, highlighting the need for reconsideration of the use of medical records as the gold standard for unintentional injury data. Caution should be used when interpreting injury data from one source, especially from families with stressful life situations. Poor communication regarding injuries between social service, primary care and urgent care providers may contribute to decreased quality of primary care and missed opportunities for injury prevention.
评估初级保健病历与产妇访谈之间伤害报告的一致性。
对一项家访随机对照试验的数据进行横断面研究。研究背景为夏威夷健康起步计划（HSP）。研究对象为有3年初级保健病历和产妇访谈记录的高危家庭儿童的基于人群的样本（n = 443）。结局指标为根据初级保健病历和产妇访谈得出的儿童在生命最初3年非故意伤害的百分比以及每个儿童的平均伤害次数。
我们共识别出490起伤害事件：48% 通过初级保健病历识别，22% 通过产妇访谈识别，30% 在两种来源中均有记录。通过初级保健病历报告受伤的儿童比通过产妇访谈报告的更多（51% 对39%，P <.001）。根据初级保健病历，每个儿童的平均伤害次数为0.87，根据产妇访谈为0.51（差值0.36，95% 置信区间0.27 - 0.45，P <.001）。数据源之间的一致性为中等（kappa = 0.47）。
本研究估计，25% 的儿童伤害事件可能未在病历中报告，这凸显了重新考虑将病历作为非故意伤害数据金标准的必要性。在解读来自单一来源的伤害数据时应谨慎，尤其是来自生活压力较大家庭的数据。社会服务、初级保健和紧急护理提供者之间关于伤害的沟通不畅可能导致初级保健质量下降以及伤害预防机会的错失。
