Validating an asthma case detection instrument in a Head Start sample

Area of Science:

• Pediatric Pulmonology
• Public Health
• Medical Diagnostics

Background:

• Asthma is a prevalent pediatric chronic condition, particularly in disadvantaged communities of color.
• Existing screening tools lack validation for early asthma detection in preschool-aged children.
• There is a critical need for validated instruments to identify children with probable asthma in early childhood settings.

Purpose of the Study:

• To develop and validate the Brief Respiratory Questionnaire (BRQ) for detecting probable asthma in preschool children.
• To assess the BRQ's accuracy and feasibility for use by nonmedical personnel in Head Start and subsidized preschools.
• To provide a tool for early identification of asthma in high-prevalence, high-morbidity communities.

Main Methods:

• A 15-item BRQ was developed and administered to parents of 419 children in Head Start settings.
• A validation interview (VAL) was conducted with parents of 200 children (149 case-positive, 51 case-negative).
• Physician assessments of summarized VALs served as the gold standard to compare BRQ classifications against.

Main Results:

• A 4-item algorithm from the BRQ demonstrated good agreement with the validation standard (kappa = .73).
• The 4-item BRQ algorithm achieved high specificity (96%), good sensitivity (73%), and a high positive predictive value (97%).
• The BRQ can be administered and scored by nonmedical preschool staff in under 5 minutes.

Conclusions:

• The Brief Respiratory Questionnaire (BRQ) is a valid and efficient tool for identifying preschool children with probable asthma.
• The BRQ is suitable for use in Head Start and similar subsidized preschool settings, particularly in underserved communities.
• This validated screening instrument can facilitate timely intervention and management of pediatric asthma.