Development and validation of school-based asthma and allergy screening questionnaires in a 4-city study.
BACKGROUND
Asthma and allergies are commonly undiagnosed in children. Schools provide settings for potentially accessing almost all children for asthma and allergy screening.


OBJECTIVE
To evaluate the feasibility and validity of using a questionnaire-based screening tool to identify undiagnosed asthma and respiratory allergies in children in kindergarten to grade 6.


METHODS
A student questionnaire (SQ) and a parent questionnaire (PQ) were developed, administered in 4 diverse communities, and validated against standardized clinical assessments. Children without diagnosed asthma and representing a range of symptoms participated in a validation study that consisted of independent, standardized, clinical assessments. Sensitivity, specificity, and predictive values for questionnaire items were evaluated against expert consensus designations.


RESULTS
A total of 190 children (age range, 7-13 years) completed the validation study. Affirmative responses to individual questions from either the SQ or PQ regarding asthma and allergy were modestly to moderately predictive of the clinical assessments (odds ratios, generally 2.5-5.0). When considering a positive asthma screen as affirmative responses to 3 of the best 7 SQ asthma questions, the odds ratio for asthma was 9.3 (95% confidence interval, 4.1-21.1), with 80% sensitivity and 70% specificity. Considering the allergy screen as positive based on affirmative response to either of the 2 SQ allergy questions yielded 81% sensitivity and 42% specificity.


CONCLUSIONS
Either a 9-item SQ or a 10-item PQ can be used in diverse settings to screen for asthma and respiratory allergies. The SQ, obtained by directly screening students, may provide a sensitive approach for detecting children with previously undiagnosed asthma and allergies.
Department of Pediatrics. Case Western Reserve University and Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA.
Susan
S
Redline
Rebecca S
RS
Gruchalla
Raoul L
RL
Wolf
Barbara P
BP
Yawn
Lydia
L
Cartar
Vanthaya
V
Gan
Patricia
P
Nelson
Peter
P
Wollan
D000293:Adolescent; D001249:Asthma / Q000175:diagnosis*; D002648:Child; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis*; D016017:Odds Ratio; D012574:Schools; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires