Mahabee-Gittens E Melinda, Merianos Ashley L, Gordon Judith S, Stone Lara, Semenova Olga, Matt Georg E
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
College of Medicine and.
Hosp Pediatr. 2019 Sep;9(9):659-664. doi: 10.1542/hpeds.2018-0247.
Documentation of children's tobacco smoke exposure (TSE) in the electronic health record (EHR) can have important implications for clinical care. However, it may not be accurate if it is not based on biochemical assessment, the most reliable method of verifying TSE. Our objectives were to compare the accuracy of EHR classification of TSE with cotinine verification and to explore parent and child variables associated with biochemically verified TSE.
Participants were 171 hospitalized pediatric patients (ages 0-17 years; mean age 5.1 [SD 3.7] years) who had EHR documentation of TSE and measured salivary cotinine. Children with cotinine levels >1 ng/mL were classified as having biochemical verification of TSE. Parents reported sociodemographic characteristics, and children's EHRs were abstracted for TSE status, past medical history, and diagnoses. We conducted χ tests to assess the agreement between EHR classification of TSE status and cotinine levels. Then, we assessed the relationship between sociodemographic and clinical variables and cotinine using crude and adjusted logistic regression models.
Overall, 71% (121 of 171) of EHR classifications were correct on the basis of cotinine levels. Specificity analyses showed that 77% (53 of 69) were correctly identified as exposed to tobacco smoke. Sensitivity analyses showed that 67% (68 of 102) were correctly identified as unexposed. The negative predictive value was 0.61 (53 of 87); 39% (34 of 87) were misclassified as unexposed. The positive predictive value was 0.81 (68 of 84); 19% (16 of 84) were misclassified as exposed.
Almost 40% of children were misclassified in the EHR as unexposed to tobacco smoke. Biochemical verification should be used as part of universal TSE screening during pediatric hospitalizations.
在电子健康记录（EHR）中记录儿童的烟草烟雾暴露（TSE）对临床护理可能具有重要意义。然而，如果它不是基于生化评估（验证TSE的最可靠方法），则可能不准确。我们的目标是比较EHR对TSE分类的准确性与可替宁验证结果，并探讨与经生化验证的TSE相关的父母和儿童变量。
研究对象为171名住院儿科患者（年龄0至17岁；平均年龄5.1[标准差3.7]岁），他们的EHR中有TSE记录且测量了唾液可替宁。可替宁水平>1 ng/mL的儿童被分类为经生化验证有TSE。父母报告了社会人口学特征，并且从儿童的EHR中提取了TSE状态、既往病史和诊断信息。我们进行χ检验以评估EHR对TSE状态的分类与可替宁水平之间的一致性。然后，我们使用粗逻辑回归模型和调整后的逻辑回归模型评估社会人口学和临床变量与可替宁之间的关系。
总体而言，根据可替宁水平，71%（171例中的121例）的EHR分类是正确的。特异性分析表明，77%（69例中的53例）被正确识别为接触过烟草烟雾。敏感性分析表明，67%（102例中的68例）被正确识别为未接触。阴性预测值为0.61（87例中的53例）；39%（87例中的34例）被错误分类为未接触。阳性预测值为0.81（84例中的68例）；19%（84例中的16例）被错误分类为接触。
近40%的儿童在EHR中被错误分类为未接触烟草烟雾。生化验证应作为儿科住院期间普遍TSE筛查的一部分使用。
