Do Patient-Answered Versus Caregiver-Answered Patient-Reported Outcomes Differ in Pediatric Upper Extremity Fracture...

Area of Science:

• Pediatric Orthopedics
• Patient-Reported Outcomes
• Cross-Informant Variance

Background:

• Patient-reported outcomes (PROs) in children are crucial for assessing treatment effectiveness.
• Self-report and caregiver proxy-report of PROs can differ, a phenomenon known as cross-informant variance.
• This variance has not been previously studied in pediatric upper extremity fracture care.

Purpose of the Study:

• To compare self-reported and caregiver proxy-reported outcomes in children with upper extremity fractures.
• To investigate the extent and clinical significance of cross-informant variance in this population.

Main Methods:

• 100 children (8-17 years) with upper extremity fractures and their caregivers completed PROMIS questionnaires.
• PROMIS domains assessed included Physical Function-Upper Extremity, Psychological Stress Experiences, and Pain-Interference.
• Paired t-tests, scatterplots, Pearson correlation, and Bland-Altman plots were used to analyze differences and agreement.

Main Results:

• Significant differences were found between child and caregiver reports across all PROMIS domains.
• Caregivers tended to overestimate pain and psychological stress, and underestimate physical function.
• Only pain interference demonstrated clinically significant disagreement (≥3 T-score points), with proportional bias observed in stress and pain domains.

Conclusions:

• Cross-informant variance exists between children and caregivers in pediatric upper extremity fracture care.
• While differences were noted in all domains, only pain interference reached clinical significance.
• The choice between self-report and proxy-report instruments requires careful consideration of potential child-caretaker disagreement in PRO assessment.