Why Parents Seek Medical Evaluations for Their Children With Mild Acute Illnesses

Voigt, Robert G.; Johnson, Shirley K.; Hashikawa, Andrew; Mellon, Michael W.; Campeau, Lynnelle J.; Williams, Arthur R.; Yawn, Barbara P.; Juhn, Young J.

doi:10.1177/0009922807308254

Cited by 8 publications

(8 citation statements)

References 22 publications

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“…(18) Recognizing this limitation, this sampling approach had an advantage over clinic-based sampling, which is limited to only subjects seeking medical evaluation. Finally, our study subjects are predominantly Caucasians (86%) and generalizability of our study findings to other study settings might be limited.…”

Section: Discussionmentioning

confidence: 99%

“…Details of study subjects were previously described. (18, 19) Briefly, the study subjects were children who were enrolled in the Mayo Clinic sick child care program and their parents to agree to participate in a previous study assessing factors associated with parents’ care-seeking behavior for mild acute illness of young children. Parents (i.e.…”

Section: Methodsmentioning

confidence: 99%

“…Some variables such as smoking exposure, parental education level, or breast-feeding history were collected by a validated questionnaire during the original study. (18)…”

Section: Methodsmentioning

confidence: 99%

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Development and initial testing of Asthma Predictive Index for a retrospective study: an exploratory study

Wi¹,

Park²,

Juhn³

2014

Journal of Asthma

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Objective Asthma Predictive Index (API) has been used for predicting asthma in prospective or cross-sectional studies, not for a retrospective study. We aim to develop and validate API for a retrospective study. Methods This is a cross-sectional study based on a convenience sample of children who participated in a previous retrospective cohort study. API was operationalized by 2 or more wheezing episodes in a year during the first 3 years of life PLUS one of the major or two of the minor criteria of the original API. We assessed validity of retrospective API against Predetermined Asthma Criteria (PAC) which has been extensively used in clinical studies for asthma. We assessed criterion validity by measuring kappa and agreement rate between API and PAC and construct validity by determining associations of API with known risk factors for asthma. Results Of the eligible 105 children, 55 (52.4%) were male, 90 (85.7%) Caucasians, and the mean age (±SD) was 5.8 years (±1.5). API criteria was met by 15 (14.3%), compared to 33 (31.4%) by PAC, respectively. The agreement rate and kappa between API and definite asthma of PAC were 89.5% and 0.66 (p<0.01). Atopic conditions, lower parental education, no history of breastfeeding, and family history of asthma were significantly associated with risk of asthma by API. Conclusions Application of API to a retrospective study for ascertaining asthma status is suitable. Our study findings need to be replicated by future studies with a larger sample size.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Development and initial testing of Asthma Predictive Index for a retrospective study: an exploratory study

Wi¹,

Park²,

Juhn³

2014

Journal of Asthma

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“…The study subjects of the original study were children under four years of age who were enrolled in the Mayo Clinic sick child care program, and their parents. 3,9 They participated in the original study that assessed factors associated with parents' care-seeking behaviour for mild acute illnesses of young children. Parents (i.e.…”

Section: Study Subjectsmentioning

confidence: 99%

Characterisation of children's asthma status by ICD-9 code and criteria-based medical record review

Juhn

Kung

Voigt

et al. 2010

Primary Care Respiratory Journal

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Objective: To characterise the relationship between ICD code-based (i.e. physician diagnosis-based) and criteria-based asthma ascertainment. Methods:We compared identification of children with asthma between criteria-based medical record review for asthma ascertainment and an ICD-9 code-based approach. We determined the agreement rate and validity index of ICD code-based asthma ascertainment using asthma status by medical record review as a gold standard.Results: Of the 115 study subjects, the agreement between medical record review and ICD-9 coding was 81.6% with a kappa value of 0.28 (P<0.0001). Sensitivity, specificity, positive and negative predictive values for ICD-9 code were 24.0%, 97.8%, 75.0%, and 82.0%, respectively, using criteria for asthma by medical record review as gold standard.Conclusions: ICD code-based asthma ascertainment appears to under-identify children with asthma compared to criteria-based medical record review. ICD codes may be useful for etiologic research but may not be suitable for surveillance of asthma epidemiology.

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“…8,9,21,22 Consequently, child care providers unaware of AAP national child care recommendations may increase parents' perceived need for urgent medical evaluations for nonurgent conditions to avoid loss of wages or missed time from work. [23][24][25][26] An estimated 50% to 80% of the 25 million pediatric visits to the emergency department are for nonurgent conditions. [27][28][29][30] High emergency department (ED) utilization for nonurgent conditions leads to increased cost, prolonged wait times, patient dissatisfaction, and adverse events.…”

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confidence: 99%

Emergency Department and Urgent Care for Children Excluded From Child Care

Hashikawa¹,

Brousseau

Singer

et al. 2014

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Previous studies have revealed that children in child care are frequently ill with mild illness and are unnecessarily excluded from child care at high rates.WHAT THIS STUDY ADDS: Parent race/ethnicity, single parents, and work-related concerns are associated with increased emergent/urgent care use for a sick child excluded from child care, even for mild illnesses.abstract BACKGROUND: Children in child care are frequently unnecessarily excluded for illness. We investigated parental use of urgent medical evaluation for sick children unable to attend child care. METHODS:In May 2012, authors conducted a nationally representative survey of parents, who completed online questions regarding child illness causing absence from child care and their medical care-seeking behavior. Main outcome was parents' use of emergency department or urgent care (ED/UC). RESULTS:Overall survey participation rate was 62%. Of participating parent cohort with children 0 to 5 years old, 57% (n = 357) required child care, of which 84% (n = 303) required out-of-home child care. Over 88% of parents sought acute medical care for their sick children unable to attend child care. Approximately one-third of parents needed a doctor' s note for employers and/or child care. Parents sought medical evaluation (.1 option possible) from primary care (81%), UC (26%), or ED (25%). ED/UC use was most common for rash (21%) and fever (15%). Logistic regression indicated ED/UC use was significantly higher among single/divorced parents (odds ratio [OR] = 4.3; 95% confidence interval [CI]: 2.5-13.5); African American parents (OR = 4.2; 95% CI: 1.2-14.6); parents needing a doctor' s note (OR = 4.2; 95% CI: 1.5-11.7); and those with job concerns (OR = 3.4; 95% CI: 1.2-9.7).CONCLUSIONS: A substantial proportion of parents whose sick children cannot attend child care seek care in ED/UC. Training child care professionals regarding appropriate illness exclusions may decrease ED/UC visits by lowering child care exclusions. Pediatrics 2014;134:e120-e127 AUTHORS:

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Why Parents Seek Medical Evaluations for Their Children With Mild Acute Illnesses

Cited by 8 publications

References 22 publications

Development and initial testing of Asthma Predictive Index for a retrospective study: an exploratory study

Development and initial testing of Asthma Predictive Index for a retrospective study: an exploratory study

Characterisation of children's asthma status by ICD-9 code and criteria-based medical record review

Emergency Department and Urgent Care for Children Excluded From Child Care

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