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Cutoff value for Pediatric Weakness Scale for diagnosis of pediatric weakness
Tae Hwan Kim1, Han Chae2, Juhui Han3
1Department of Korean Pediatrics, College of Korean Medicine, Kyung Hee University Medical Center, Kyung Hee University, Seoul 02447, Republic of Korea.
Insights
This study established cutoff values for the Pediatric Weakness Scale (PWS) to aid in diagnosing pediatric weakness in children. These new PWS cutoff values improve the assessment of weakness in children experiencing frequent minor illnesses.
Area of Science:
- Integrative Medicine
- Pediatrics
- Traditional Korean Medicine
Background:
- Children with frequent minor illnesses, fatigue, and poor appetite are diagnosed with weakness in traditional Korean medicine.
- The Pediatric Weakness Scale (PWS) is validated for assessing pediatric weakness, but lacks standardized cutoff values.
- Establishing reliable cutoff values is crucial for accurate diagnosis and management of pediatric weakness.
Purpose of the Study:
- To develop and validate cutoff values for the Pediatric Weakness Scale (PWS).
- To enhance the diagnostic accuracy of the PWS for pediatric weakness.
- To provide a standardized tool for assessing weakness in children.
Main Methods:
- A survey administered to parents of children aged 6-9 years measured PWS, fatigue, behavior, eating habits, growth indices, and respiratory infection frequency/duration.
- Correlations between PWS and other measures were analyzed using Pearson's or Spearman's correlation.
- Receiver-operating characteristic (ROC) curves were generated for PWS subscales based on visceral theories to determine cutoff values maximizing Youden's index.
Main Results:
- Significant correlations were found between PWS subscales (liver, heart, spleen, lung, kidney) and various health indicators including fatigue, behavior, eating habits, and respiratory infections.
- Distinct differences in PWS subscales were observed between weak and normal children.
- Validated cutoff values for liver, heart, spleen, lung, and kidney weakness were determined as 4.50, 7.50, 4.50, 4.50, and 4.50, respectively, with high sensitivity (up to 84.6%) and specificity (up to 82.5%).
Conclusions:
- The derived cutoff values for the PWS provide a valuable tool for diagnosing and assessing pediatric weakness.
- These standardized cutoff values will improve the clinical application of the PWS in integrative traditional Korean medicine.
- The study successfully established reliable diagnostic criteria for pediatric weakness using the PWS.
Objective:
In integrative traditional Korean medicine, children without abnormalities on medical examination but who frequently experience minor illnesses, fatigue and poor appetite are diagnosed as children with weakness. The Pediatric Weakness Scale (PWS) is a validated questionnaire for assessing pediatric weakness, but no standardized cutoff value exists. This study aimed to develop a validated cutoff value for PWS.
Methods:
Parents of children aged 6-9 years were administered a survey to measure PWS, PedsQL™ Multidimensional Fatigue Scale (MFS), Korean Child Behavior Checklist (K-CBCL), Korean version of the Children's Eating Behavior Questionnaire (K-CEBQ), child growth indices, frequency of respiratory infections, and average duration of respiratory infections. The correlation between PWS and the results of each survey was analyzed using Pearson's or Spearman's correlation. The differences between the weak and normal groups were compared using independent sample t-tests or Mann-Whitney U tests. Receiver-operating characteristic (ROC) curves for the PWS subscale were generated based on five visceral theories (liver, heart, spleen, lung and kidney). The cutoff value was determined at the point that maximized Youden's index on the ROC curve.
Results:
A total of 326 parents participated in the study. In PWS, the liver weakness index was significantly correlated with the MFS, heart weakness index with the K-CBCL, spleen weakness index with the K-CEBQ, lung weakness index with the frequency of respiratory infections, average duration of respiratory infections in the past year, and kidney weakness index with birth weight, height percentile, and weight percentile. Significant differences in each PWS subscale were observed between the weak and normal children. The cutoff values for diagnosing weakness in the liver, heart, spleen, lung and kidney were 4.50, 7.50, 4.50, 4.50 and 4.50, respectively, with sensitivity and specificity reaching up to 84.6% and 82.5%.
Conclusion:
The cutoff values for PWS derived from this survey will be a useful tool for diagnosing and assessing pediatric weakness. Please cite this article as: Kim TH, Chae H, Han JH, Bang MR, Chang GT, Lee JY, Lee SH. Cutoff value for Pediatric Weakness Scale for diagnosis of pediatric weakness. J Integr Med. 2026; 24(1):105-114.
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