Abstract
There is concern regarding the underdiagnosis and undertreatment of asthma in children. This pilot study was designed to determine the specificity, sensitivity, and feasibility of using a two-part (child + parent questionnaire) case finding tool (Video-guided Asthma Screening for Children-School Age, VASC-SA) to identify elementary school children with asthma. The child checklist includes two practice items and nine items asking about asthma symptoms and diagnosis. The items are visually cued using a 10-min videotape using split-screen vignettes, one corresponding to a no response (most children do not...) and one to a yes response (some children...). Three case definition algorithms were examined (all included inhaled medication, or current diagnosis, or wheeze with 0, 1, or 2 other symptoms). The VASC-SA was administered to English-speaking children in grades 1-4 from one school. All parents were sent a written asthma questionnaire. Positive screens were compared with diagnosis obtained from physician report or parent interview. Three-hundred fifty matched parent-child responses were analyzed. Asthma prevalence in this sample ranged from 14 to 14.9% using VACS-SA case definitions. Sensitivity for the three definitions ranged from 79 to 81% and specificity ranged from 94.5 to 95%. The predictive value positive ranged from 66 to 69% and predictive value negative was 97%. Concordance of child and parent reports was highest for previous asthma diagnosis and use of inhaled medication. The VASC-SA appears to be a promising new epidemiological tool to facilitate asthma screening in elementary schools. Prescreening children before parents may offer a practical approach in a large community-based population.
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