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Children's health status instruments: their potential application in the emergency department
Melissa L McCarthy1, Ellen J MacKenzie, Dennis R Durbin
1Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Md, USA. mmccarth@jhmi.edu
Insights
Pediatric health status instruments offer a multidimensional view of child well-being beyond traditional measures. Their use in emergency medicine can improve care evaluation, despite existing challenges in measurement and application.
Area of Science:
- Pediatric Health Measurement
- Emergency Medicine Research
- Child Health Outcomes
Background:
- Traditional clinical benchmarks focus on impairment, not multidimensional health.
- Recent development of instruments using measurement science principles for child health.
- Health is viewed as multidimensional, incorporating physical, mental, and social aspects from the child's or parent's perspective.
Purpose of the Study:
- To provide an overview of child health status instruments.
- To explore their potential application by emergency medicine researchers.
- To highlight how these instruments can broaden the evaluation of emergency care.
Main Methods:
- Review of existing child health status instruments.
- Discussion of their application in emergency department (ED) settings.
- Identification of challenges and methodologic issues in measurement and application.
Main Results:
- Child health status instruments measure physical, mental, and social health multidimensionally.
- Potential applications in ED include evaluating interventions, assessing disposition, and detecting underlying problems.
- Challenges include defining child health universally, developmental/social context, eliciting data from young children, and ED-specific issues.
Conclusions:
- Despite challenges, pediatric health status instruments should be adopted in emergency medicine.
- Adoption will drive instrument improvement and methodological advances.
- Increasing focus on nonfatal consequences necessitates broader use of these measures.
Objective:
To provide an overview of child health status instruments and their potential application by emergency medicine researchers.
Conclusions:
Numerous instruments have recently been developed to measure children's physical, mental, and social health using sound principles of measurement science. These instruments differ from traditional clinical benchmarks of impairment. Health is conceived to be multidimensional and is measured from the child's and/or parents' perspective. Child health status instruments can be used to broaden the evaluation of emergency care in the following ways: 1) to evaluate emergency department (ED) interventions in terms of improvements in children's everyday activities and well-being; 2) to assess the appropriateness of ED disposition and follow-up services; and 3) to detect underlying health and social problems. Using these instruments in the ED will be challenging. Methodologic issues remain regarding the measurement of children's health. The most pressing issues are the absence of a universal definition of children's health, the need to take into account the developmental and social contexts of children, and the difficulties in eliciting information from very young children. In addition, the ED presents its own set of challenges. These include the lack of pre-injury/pre-illness measures, the absence of case-mix severity instruments, and the difficulty of isolating the effect of ED treatment on patients' health.
Recommendations:
Despite these challenges, it is time to use pediatric health status instruments in emergency medicine. Only with their adoption will instruments improve and advances in methodology occur. As patients, providers, and policy makers increasingly focus their attention on the nonfatal consequences of injury and illness, the broader use of these measures becomes imperative.