Validity of patient-supplied medical history data comparing two medical questionnaires.
In many European countries there has been a significant shift in the age structure of the population, resulting in a marked rise in the number of elderly, medically compromised patients. Early identification of possible medical risk factors is therefore increasingly gaining in importance in the treatment of dental patients. It was the aim of the present study to evaluate two different patient-administered questionnaires with a view to both the validity of medical history data supplied by the patients and the identification of a possible risk potential. A comprehensive form (A, specially designed for treatment under general anaesthesia, 50 questions) and a shorter form (B, for routine use in general dental practices, 37 questions) were randomly distributed to patients of two dental practices (n = 194). Data supplied by the patients were checked against those provided by the general practitioners and risk assessment was performed based on the American Society of Anaesthesiologists (ASA) physical status classification system. A total of 161 medical history forms were evaluated (A: 81 test persons, B: 80 test persons). A close relationship was observed between increased age and higher ASA classification. The evaluation of the two history forms yielded an overall sensitivity of 80% for form A and of 61% for form B (specificity 96% and 98%, respectively). With both forms, agreement between the data supplied by the patients and by the dental practitioner was highest for ASA Grade I patients (A: 88%, B:02%). However, agreement between patient and general practitioner-supplied data was lower for ASA Grade III patients with both forms (A: 92%, B: 72%). Risk overestimation with form A occurred in 6 % and with form B in 5% of cases, while the medical risk was underestimated with form A in 5% and with form B in 11% of cases. Although results of the present study emphasise the need for meticulous and thorough history taking, neither the more concise form B nor the more comprehensive and detailed form A was able to exclude the occurrence of false-positive or false-negative answers. Particularly the lack of validity observed for patient-supplied data, which resulted in higher medical risk classifications despite the use of a comprehensive medical history questionnaire, mandates the improvement and possible reorientation of interdisciplinary co-operation between the dentist and the general practitioner.
Pistorius
A
A
Department for Operative Dentistry, Johannes Gutenberg University Mainz, Augustusplatz 2, D-55131 Mainz, Germany.
Kunz
M
M
Jakobs
W
W
Willershausen
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D003813:Dentistry; D005060:Europe; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D010361:Patients; D015203:Reproducibility of Results; D012307:Risk Factors; D011795:Surveys and Questionnaires