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Apgar scores reported in personal child health records: validity for epidemiological studies?
Pénélope Troude1, Laurence Foix L'Hélias, Anne-Marie Raison-Boulley
1Ined, F-75020 Paris, France.
Insights
Apgar scores in personal child health records (PCHRs) may be unreliable for epidemiological studies. Data suggests scores are often altered, especially when low, impacting long-term child health research validity.
Area of Science:
- Pediatrics
- Epidemiology
- Neonatal Health
Background:
- Personal child health records (PCHRs) are widely used globally.
- PCHRs contain neonatal information potentially impacting long-term child health.
- Validating PCHR data is crucial for epidemiological research.
Purpose of the Study:
- To assess the validity of Apgar scores recorded in PCHRs.
- To compare PCHR Apgar scores against maternity medical records as the gold standard.
- To evaluate the reliability of PCHR data for epidemiological studies.
Main Methods:
- A cohort of 435 women and their newborns in two French hospitals were studied.
- Neonatal information, including Apgar scores, was copied from PCHRs via questionnaire.
- PCHR data was compared with physician-recorded data in maternity medical records.
Main Results:
- Higher rates of missing Apgar scores in PCHRs correlated with lower scores in medical records.
- Apgar scores in PCHRs were frequently overestimated when medical record scores were low.
- PCHR 1-min Apgar score sensitivity was 33% and specificity 100% compared to medical records.
Conclusions:
- Apgar scores in PCHRs may not provide reliable data for epidemiological research.
- Potential intentional alteration of 'socially sensitive' information in PCHRs is suggested.
- Consider alternative composite neonatal indicators if PCHR is the sole data source.
Aim:
In epidemiological studies on children, information in the neonatal period that might affect children's long-term health could be extracted from the personal child health record (PCHR), because the booklet exists in most countries. We aimed to assess, in individual children, the validity of Apgar scores reported in the PCHR using maternity medical records as the gold standard.
Methods:
In two French hospitals, 435 women who had a child in January 2006 were recruited and 90% filled in a postal questionnaire 6 weeks after delivery, copying neonatal information (including Apgar scores) from the PCHR. This information was compared with data independently recorded at birth by physicians in maternity medical records.
Results:
We found that the proportion of missing Apgar scores in the PCHR was higher when scores in the medical records were lower. Moreover, Apgar scores reported in the PCHR were overestimated when scores in the medical records were low. Using medical records as the gold standard, specificity for PCHR-reported 1-min Apgar score was 100% and sensitivity 33%. Similar trends were found for the 5-min score. This supports the hypothesis that information considered as 'socially sensitive' by physicians may be intentionally altered in PCHRs.
Conclusions:
Apgar scores reported in PCHRs may not yield reliable information for epidemiological studies. When the PCHR is the only source of information for the neonatal period in an epidemiological study, it would be preferable to use a composite neonatal indicator rather than the Apgar score.
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