title: Agreement between self-report and medical records on  signs and symptoms of respiratory illness.
abstract: BACKGROUND
  Information on patient symptoms can be obtained by patient self-report or medical records review. Both methods have limitations.
  
  
  OBJECTIVE
  To assess the agreement between self-report and documentation in the medical records of signs/symptoms of respiratory illness (fever, cough, runny nose, sore throat, headache, sinus problems, muscle aches, fatigue, earache, and chills).
  
  
  METHODS
  Respondents were 176 research participants in the Hutterite Influenza Prevention Study during the 2008-2009 influenza season with information about the presence or absence of signs/symptoms from both self-report and primary care medical records.
  
  
  RESULTS
  Compared with medical records, lower proportions of self-reported fever, sore throat, earache, cough, and sinus problems were found. Total agreements between self-report and medical report of symptoms ranged from 61% (for sore throat) to 88% (for muscle aches and earache), with kappa estimates varying from 0.05 (for chills) to 0.41 (for cough) and 0.51 (for earache). Negative agreement was considerably higher (from 68% for sore throat to 93% for muscle aches and earache) than positive agreement (from 13% for chills to 58% for earache) for each symptom except cough where positive agreement (77%) was higher than negative agreement (64%). Agreements varied by age group. We found better agreement for earache (kappa = 0.62) and lower agreements for headache, sinus problems, muscle aches, fatigue, and chills in older children (aged >5 years) and adults.
  
  
  CONCLUSIONS
  Agreements were variable depending on the specific symptom. Contrary to research in other patient populations which suggests that clinicians report fewer symptoms than patients, we found that the medical record captured more symptoms than selfreport. Symptom agreement and disagreement may be affected by the perspectives of the person experiencing them, the observer, the symptoms themselves, measurement error, the setting in which the symptoms were observed and recorded, and the broader community and cultural context of patients.
authors.affiliation: Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada. barbara@mcmaster.ca
authors.forename: Angela M
authors.initials: AM
authors.lastname: Barbara
authors.forename: Mark
authors.initials: M
authors.lastname: Loeb
authors.forename: Lisa
authors.initials: L
authors.lastname: Dolovich
authors.forename: Kevin
authors.initials: K
authors.lastname: Brazil
authors.forename: Margaret
authors.initials: M
authors.lastname: Russell
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000175:diagnosis; D004433:Earache / Q000175:diagnosis; D005260:Female; D005334:Fever / Q000175:diagnosis; D006801:Humans; D007251:Influenza, Human / Q000175:diagnosis; D008297:Male; D008499:Medical Records / Q000592:standards; D008875:Middle Aged; D010254:Paranasal Sinus Diseases / Q000175:diagnosis; D010612:Pharyngitis / Q000175:diagnosis; D012140:Respiratory Tract Diseases / Q000175:diagnosis*; D057566:Self Report; D055815:Young Adult