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Published on: August 7, 2017
Comparability of parent reports of respiratory illnesses with clinical diagnoses in infants
J M Samet1, A H Cushing, W E Lambert
1Department of Medicine, University of New Mexico Medical Center, Albuquerque.
Insights
Parent telephone reports accurately identify most lower respiratory illnesses (LRIs) in children but often misclassify them. This highlights challenges in using symptom surveillance for precise LRI diagnosis.
Area of Science:
- Pediatric respiratory health
- Epidemiological surveillance methods
- Clinical diagnosis validation
Background:
- Accurate assessment of respiratory illnesses in young children is crucial for effective public health monitoring.
- Parental reporting of symptoms is a common method for tracking childhood illnesses, but its clinical accuracy needs evaluation.
- Distinguishing between upper and lower respiratory illnesses is important for appropriate clinical management.
Purpose of the Study:
- To evaluate the accuracy of parent-reported respiratory symptoms in identifying lower respiratory illnesses (LRIs) in children from birth to 18 months.
- To compare parent symptom reports with clinical diagnoses made by nurse practitioners and outpatient clinic records.
- To assess the feasibility of using telephone surveillance for standardized reporting of pediatric respiratory illnesses.
Main Methods:
- A cohort study enrolled 1,315 subjects from birth through 18 months.
- Illnesses were monitored via telephone reports of respiratory symptoms.
- Clinical validation involved examinations by a nurse practitioner and review of outpatient records; LRIs were defined by specific symptom durations (e.g., wet cough, wheeze).
Main Results:
- The study analyzed 10,771 reported illnesses.
- Parental reports of wet cough or wheeze showed high sensitivity (93.4%) for detecting LRIs but low specificity (24.2%), with many false positives.
- Comparison with nurse practitioner diagnoses and outpatient records yielded similar findings regarding the accuracy of parent reports.
Conclusions:
- Telephone surveillance systems can standardize the reporting of pediatric respiratory illnesses.
- However, relying solely on symptom surveillance data may lead to misclassification of specific illnesses compared to clinical diagnoses.
- Further refinement is needed to improve the specificity of symptom-based surveillance for accurate LRI diagnosis in children.
Abstract:
In a cohort study of respiratory illnesses from birth through age 18 months, the investigators assessed the occurrence of illness by telephone reports of respiratory symptoms. To assess the comparability of illness events based on symptom reports with usual clinical modalities, a nurse practitioner examined children during illnesses, and office and clinic records of outpatient visits were reviewed. Respiratory illnesses were defined as symptom episodes of at least 2 days; lower respiratory illnesses included at least 1 day of either wet cough or wheeze. This report is based on 10,771 illnesses in the 1,315 subjects enrolled. Runny or stuffy nose was reported for most (93%) illnesses, wet cough in 33%, and wheeze in 6%. In comparison with the diagnoses made by a nurse practitioner, parent report of wet cough or wheeze was sensitive (93.4%) for detecting lower respiratory illnesses, but nonspecific with specificity of only 24.2%. The majority of the false-positive lower respiratory illnesses had the symptom of wet cough. The comparison of parent reports with outpatient records provided similar findings. Standardized reporting of respiratory illnesses can be achieved with a telephone surveillance system but classification of specific illnesses from the surveillance information may differ from diagnoses made by clinicians.
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