Validation of a multistage asthma case-detection procedure for elementary school children.
OBJECTIVE
The purpose of this study was to validate a 3-stage asthma case-detection procedure for elementary school-aged children.


METHODS
The study was performed in 10 elementary schools in 4 inner-city school systems, with a total enrollment of 3539 children. Results of the case-detection procedure were compared with the diagnosis of an asthma specialist study physician, to determine the sensitivity and specificity of the case-detection procedure.


RESULTS
Ninety-eight percent of children returned the asthma symptoms questionnaires, and 79% of those children consented to additional testing. Results indicated that the 3-stage procedure had good validity, with sensitivity, specificity, and predictive value of 82%, 93%, and 93%, respectively. A 2-stage procedure using questionnaires and spirometry had similar validity, with sensitivity, specificity, and predictive value of 78%, 93%, and 93%, respectively. However, given the time and expense associated with the 2- or 3-stage procedure and the difficulty of obtaining physician follow-up evaluation of the case-detection diagnosis, schools may prefer to use a 2-item questionnaire that has a lower sensitivity (66%) but higher specificity (96%) and predictive value (95%).


CONCLUSIONS
Case-detection programs are generally well received by school personnel and can identify children with unrecognized or undiagnosed disease, as well as those with a current diagnosis but poorly controlled disease. This study yields substantial information regarding the validity, yield, and specific types of children who might be identified with the use of such procedures. For the choice of the method of case detection used in a school, the strengths and weaknesses of each procedure, as well as the resources available for case detection, physician referral, and follow-up procedures, must be considered.
Gerald
Lynn B
LB
Lung Health Center, University of Alabama at Birmingham, 620 S 20th St, NHB 104, Birmingham, AL 35233-7337, USA. geraldl@uab.edu
Grad
Roni
R
Turner-Henson
Anne
A
Hains
Coralie
C
Tang
Shenghui
S
Feinstein
Ronald
R
Wille
Keith
K
Erwin
Sue
S
Bailey
William C
WC
D001249:Asthma / Q000175:diagnosis*; D002648:Child; D005080:Exercise Test; D005188:False Negative Reactions; D005541:Forced Expiratory Volume; D006801:Humans; D015203:Reproducibility of Results; D012572:School Health Services; D012680:Sensitivity and Specificity; D013147:Spirometry; D011795:Surveys and Questionnaires; D014505:Urban Population; D014797:Vital Capacity