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Control of Allergic Rhinitis and Asthma Test for Children (CARATkids): A systematic review and meta-analysis of its
Hadla Sami El Didi1, Ana Margarida Pereira1, Cristina Jácome1
1Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, RISE-Health, University of Porto, Porto, Portugal.
Insights
The Control of Allergic Rhinitis and Asthma Test for Children (CARATkids) is a reliable tool for assessing both allergic rhinitis and asthma in children. This review confirms its suitability for simultaneous evaluation of these common pediatric conditions.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Psychometrics
Background:
- The Control of Allergic Rhinitis and Asthma Test for Children (CARATkids) is a unique patient-reported outcome measure (PROM) designed for simultaneous assessment of allergic rhinitis and asthma in children.
- Existing validations across multiple languages and countries necessitate a comprehensive review of its psychometric properties to ensure its continued utility.
Purpose of the Study:
- To systematically evaluate the measurement properties of the CARATkids tool.
- To assess the reliability, validity, and responsiveness of CARATkids based on existing literature.
Main Methods:
- A systematic review adhering to PRISMA and COSMIN guidelines was conducted.
- Searches were performed across Ovid/MEDLINE, Web of Science, and Scopus databases, updated in June 2025.
- Nine studies focusing on CARATkids development, adaptation, or validation were included for analysis, including a meta-analysis of measurement properties.
Main Results:
- CARATkids demonstrated sufficient content validity and strong internal consistency (Cronbach's alpha = 0.81).
- Reliability was sufficient (ICC = 0.86), with a minimal clinically important difference of 2.76.
- Evidence supported construct validity (Spearman coefficients 0.37–0.71) and responsiveness, showing strong correlations with other outcome measures.
Conclusions:
- The CARATkids tool exhibits robust psychometric properties, supporting its use.
- CARATkids is confirmed as a suitable instrument for simultaneously assessing asthma and allergic rhinitis in children aged 6–12 years.
- This systematic review provides strong evidence for the clinical utility of CARATkids in pediatric respiratory care.
Abstract:
Control of Allergic Rhinitis and Asthma Test for Children (CARATkids) is the first patient-reported outcome measure (PROM) designed to assess both allergic rhinitis and asthma simultaneously in children aged 6 to 12 years. CARATkids has been validated in several languages and countries, highlighting the need for a review of its psychometric properties. This study aims to evaluate the measurement properties of CARATkids. This systematic review follows PRISMA and COSMIN guidelines. A systematic search was performed across three databases (Ovid/MEDLINE, Web of Science, and Scopus in October 2023, updated in June 2025). We included studies focused on the development, cultural adaptation, or validation of CARATkids, as well as studies comparing CARATkids with other PROMs. We evaluated the quality of CARATkids development, the methodological quality of primary studies, the overall rating, and the certainty of evidence for each CARATkids measurement property and performed a meta-analysis of its measurement properties. Our search retrieved 193 results. We included nine studies. CARATkids displayed sufficient content validity. Regarding internal consistency, we found a meta-analytical Cronbach alpha of 0.81 (95% CI = 0.79; 0.83). CARATkids displayed sufficient reliability (meta-analytical intraclass correlation coefficient 0.86 [95% CI = 0.61; 0.96]). The minimal clinically important difference was 2.76. Construct validity had sufficient evidence for most correlations, with absolute meta-analytical Spearman coefficients from 0.37 to 0.71. Responsiveness showed strong correlations between CARATkids and most outcome measurement instruments. These findings support CARATkids as a suitable tool for assessing asthma and allergic rhinitis in children aged 6 to 12 years who present both conditions simultaneously.
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