title: Apgar scores reported in personal child health records: validity for epidemiological studies?
abstract: OBJECTIVE
  In epidemiological studies on children, information in the neonatal period that might affect children's long-term health could be extracted from the personal child health record (PCHR), because the booklet exists in most countries. We aimed to assess, in individual children, the validity of Apgar scores reported in the PCHR using maternity medical records as the gold standard.
  
  
  METHODS
  In two French hospitals, 435 women who had a child in January 2006 were recruited and 90% filled in a postal questionnaire 6 weeks after delivery, copying neonatal information (including Apgar scores) from the PCHR. This information was compared with data independently recorded at birth by physicians in maternity medical records.
  
  
  RESULTS
  We found that the proportion of missing Apgar scores in the PCHR was higher when scores in the medical records were lower. Moreover, Apgar scores reported in the PCHR were overestimated when scores in the medical records were low. Using medical records as the gold standard, specificity for PCHR-reported 1-min Apgar score was 100% and sensitivity 33%. Similar trends were found for the 5-min score. This supports the hypothesis that information considered as 'socially sensitive' by physicians may be intentionally altered in PCHRs.
  
  
  CONCLUSIONS
  Apgar scores reported in PCHRs may not yield reliable information for epidemiological studies. When the PCHR is the only source of information for the neonatal period in an epidemiological study, it would be preferable to use a composite neonatal indicator rather than the Apgar score.
authors: Ined, F-75020 Paris, France.
authors: Pénélope
authors: P
authors: Troude
authors: Laurence Foix
authors: LF
authors: L'Hélias
authors: Anne-Marie
authors: AM
authors: Raison-Boulley
authors: Christine
authors: C
authors: Castel
authors: Jean
authors: J
authors: Bouyer
authors: Elise
authors: E
authors: de La Rochebrochard
mesh_terms: D000328:Adult; D001034:Apgar Score; D016021:Epidemiologic Studies; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008499:Medical Records / Q000592:standards*; D011795:Surveys and Questionnaires; D055815:Young Adult