Children's health status instruments: their potential application in the emergency department.
OBJECTIVE
To provide an overview of child health status instruments and their potential application by emergency medicine researchers.


CONCLUSIONS
Numerous instruments have recently been developed to measure children's physical, mental, and social health using sound principles of measurement science. These instruments differ from traditional clinical benchmarks of impairment. Health is conceived to be multidimensional and is measured from the child's and/or parents' perspective. Child health status instruments can be used to broaden the evaluation of emergency care in the following ways: 1) to evaluate emergency department (ED) interventions in terms of improvements in children's everyday activities and well-being; 2) to assess the appropriateness of ED disposition and follow-up services; and 3) to detect underlying health and social problems. Using these instruments in the ED will be challenging. Methodologic issues remain regarding the measurement of children's health. The most pressing issues are the absence of a universal definition of children's health, the need to take into account the developmental and social contexts of children, and the difficulties in eliciting information from very young children. In addition, the ED presents its own set of challenges. These include the lack of pre-injury/pre-illness measures, the absence of case-mix severity instruments, and the difficulty of isolating the effect of ED treatment on patients' health.


CONCLUSIONS
Despite these challenges, it is time to use pediatric health status instruments in emergency medicine. Only with their adoption will instruments improve and advances in methodology occur. As patients, providers, and policy makers increasingly focus their attention on the nonfatal consequences of injury and illness, the broader use of these measures becomes imperative.
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Md, USA. mmccarth@jhmi.edu
Melissa L
ML
McCarthy
Ellen J
EJ
MacKenzie
Dennis R
DR
Durbin
D002648:Child; D002669:Child Welfare; D004636:Emergency Service, Hospital / Q000592:standards*; D006302:Health Services Research; D006305:Health Status Indicators; D006801:Humans; D017063:Outcome Assessment, Health Care; D010372:Pediatrics / Q000592:standards*