Published online October 1, 2004
PEDIATRICS Vol. 114 No. 4 October 2004, pp. e459-e468 (doi:10.1542/peds.2004-0455)
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ELECTRONIC ARTICLE

Validation of a Multistage Asthma Case-Detection Procedure for Elementary School Children

Lynn B. Gerald, PhD, MSPH*,{ddagger}, Roni Grad, MD§, Anne Turner-Henson, DSN||, Coralie Hains, MD§, Shenghui Tang, PhD, Ronald Feinstein, MD§, Keith Wille, MD{ddagger}, Sue Erwin, RRT*,{ddagger} and William C. Bailey, MD*,{ddagger}

* Lung Health Center
{ddagger} Division of Pulmonary, Allergy, and Critical Care Medicine
§ Department of Pediatrics
|| Department of Nursing
Department of Medicine, Medical Statistics Section, University of Alabama at Birmingham, Birmingham, Alabama

Objective. The purpose of this study was to validate a 3-stage asthma case-detection procedure for elementary school-aged children.

Methods. The study was performed in 10 elementary schools in 4 inner-city school systems, with a total enrollment of 3539 children. Results of the case-detection procedure were compared with the diagnosis of an asthma specialist study physician, to determine the sensitivity and specificity of the case-detection procedure.

Results. Ninety-eight percent of children returned the asthma symptoms questionnaires, and 79% of those children consented to additional testing. Results indicated that the 3-stage procedure had good validity, with sensitivity, specificity, and predictive value of 82%, 93%, and 93%, respectively. A 2-stage procedure using questionnaires and spirometry had similar validity, with sensitivity, specificity, and predictive value of 78%, 93%, and 93%, respectively. However, given the time and expense associated with the 2- or 3-stage procedure and the difficulty of obtaining physician follow-up evaluation of the case-detection diagnosis, schools may prefer to use a 2-item questionnaire that has a lower sensitivity (66%) but higher specificity (96%) and predictive value (95%).

Conclusions. Case-detection programs are generally well received by school personnel and can identify children with unrecognized or undiagnosed disease, as well as those with a current diagnosis but poorly controlled disease. This study yields substantial information regarding the validity, yield, and specific types of children who might be identified with the use of such procedures. For the choice of the method of case detection used in a school, the strengths and weaknesses of each procedure, as well as the resources available for case detection, physician referral, and follow-up procedures, must be considered.

Key Words: asthma • children • case detection

Abbreviations: UAB, University of Alabama at Birmingham • BHR, bronchial hyperresponsiveness • FEV1, forced expiratory volume in 1 second • FVC, forced vital capacity • NAEPP, National Asthma Education and Prevention Program • IAAP, individualized asthma action plan

Accepted May 7, 2004.




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