R Christopher Sheldrick, Justin Birudavol, Dina R Hirshfeld-Becker, Alice S Carter, Ellen C Perrin, Anamika Dutta, Talia S Benheim, Juliana M Holcomb, Alexy Arauz Boudreau, Michael S Jellinek, J Michael Murphy
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引用次数: 0
Abstract
Background: In 2022, the American Academy of Pediatrics recommended annual social/emotional/behavioral (SEB) screening at preventive pediatric visits. Numerous SEB screeners have considerable empirical support for children of all ages. However, few studies inform the longitudinal use of SEB screeners in pediatrics.
Methods: Using electronic health records (EHR) from seven pediatric clinics in a large hospital system, we analyze the longitudinal stability of three SEB screeners among 9,153 children and adolescents who were screened multiple times over a 3-year period, and we evaluate associations with International Classification of Disease (ICD) codes for SEB diagnoses.
Results: Moderate stability was documented for the Baby Pediatric Symptom Checklist (ICC =.57), Preschool Pediatric Symptom Checklist (ICC =.60), and Pediatric Symptom Checklist-17 (ICC =.69). Stability of positive/negative results was sensitive to each screener's threshold. Across a range of thresholds that classify 7-20% of children as positive, all three screeners achieved positive predictive values (PPVs) of approximately 40-65% and diagnostic odds ratios ranging from 8 to 15. These findings compare favorably to published results for longer measures and structured interviews. Recommended thresholds varied markedly across screeners, and associations with ICD codes demonstrate that higher thresholds yield higher specificity but lower sensitivity (i.e., a majority of ICD codes are not anticipated by positive screens).
Conclusions: Three common SEB screeners display longitudinal stability similar to longer, more established measures. Results demonstrate that recommended thresholds vary markedly across measures and that choice of threshold strongly influences sensitivity and specificity, underscoring the need for greater attention to selection of thresholds. CLINICAL TRIAL REGISTRATION (IF ANY): none.
期刊介绍:
Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.