Smelley Cade C, McDonald Tyler C
From the Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL (Smelley), and the Division of Pediatric Orthopaedics (Dr. McDonald), Department of Orthopaedic Surgery, Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL.
J Am Acad Orthop Surg. 2025 May 1;33(9):488-495. doi: 10.5435/JAAOS-D-24-01046. Epub 2024 Dec 18.
Patient-reported outcomes in children can be assessed using self-report or caregiver proxy-report; however, self-reported and proxy-reported outcomes often vary between respondents, a phenomenon called cross-informant variance. This phenomenon has not been studied in pediatric fracture care. This study compares self-reported and proxy-reported patient-reported outcomes in children being treated for upper extremity fractures.
Children aged 8 to 17 with upper extremity fractures completed pediatric self-report questionnaires and their caregivers completed parent proxy-report questionnaires composed of items from three Patient-Reported Outcomes Measurement Information System (PROMIS) domains (Physical Function-Upper Extremity, Psychological Stress Experiences, and Pain-Interference). Mean patient and caregiver T-scores for each domain were compared using paired T-tests. Correlation between scores was assessed using scatterplots and Pearson correlation coefficient. Agreement between child and caregiver T-scores was assessed using Bland-Altman plots.
One hundred child-caregiver dyads were included. Patients' mean age was 12.3 years, and 68% were male. Statistically significant differences were found between mean patient and caregiver T-scores in all PROMIS domains. Caregivers overestimated patient pain and psychological stress and underestimated upper extremity function. However, only the disagreement in the Pain-Interference domain met the threshold of clinical significance, a difference of three or more T-score points. Bland-Altman analysis revealed proportional bias in the Psychological Stress Experiences and Pain-Interference domains. With higher T-scores, caregivers tended to overestimate psychological stress to a greater extent but tended toward agreement with their children for pain.
This study identified cross-informant variance between children and caretakers in the setting of pediatric upper extremity fractures. Although notable differences were observed in all PROMIS domains included, only one met the level of clinical significance, suggesting that not all domains are equally susceptible to child-caretaker disagreement. As patient-reported outcomes become more used in pediatric settings, the possibility of cross-informant variance must be considered when choosing to use self-report or proxy-report instruments.
Level III.
儿童患者报告的结局可通过自我报告或照顾者代理报告进行评估；然而，自我报告和代理报告的结局在受访者之间往往存在差异，这种现象称为信息提供者差异。这种现象在儿童骨折护理中尚未得到研究。本研究比较了上肢骨折患儿自我报告和代理报告的患者报告结局。
8至17岁的上肢骨折患儿完成儿科自我报告问卷，其照顾者完成由三个患者报告结局测量信息系统（PROMIS）领域（上肢身体功能、心理应激经历和疼痛干扰）的项目组成的家长代理报告问卷。使用配对t检验比较每个领域的患者和照顾者平均T分数。使用散点图和Pearson相关系数评估分数之间的相关性。使用Bland-Altman图评估儿童和照顾者T分数之间的一致性。
纳入了100对儿童-照顾者二元组。患者的平均年龄为12.3岁，68%为男性。在所有PROMIS领域中，患者和照顾者的平均T分数之间存在统计学显著差异。照顾者高估了患者的疼痛和心理应激，低估了上肢功能。然而，只有疼痛干扰领域的差异达到了临床意义阈值，即T分数相差三个或更多点。Bland-Altman分析显示心理应激经历和疼痛干扰领域存在比例偏差。随着T分数升高，照顾者往往在更大程度上高估心理应激，但在疼痛方面倾向于与孩子的意见一致。
本研究确定了儿童上肢骨折情况下儿童与照顾者之间的信息提供者差异。尽管在所纳入的所有PROMIS领域中都观察到了显著差异，但只有一个领域达到了临床意义水平，这表明并非所有领域都同样容易出现儿童-照顾者意见不一致的情况。随着患者报告结局在儿科环境中越来越多地被使用，在选择使用自我报告或代理报告工具时，必须考虑信息提供者差异的可能性。
三级。
