title: Health-related quality of life in pediatric Chiari Type I malformation: the Chiari Health Index for Pediatrics.
abstract: OBJECT The purpose of this study was to design and validate a patient-reported health-related quality of life (HRQOL) instrument for pediatric Chiari Type I malformation (CM-I), the Chiari Health Index for Pediatrics (CHIP). METHODS The CHIP has 45 items with 4 components making up 2 domain scores, physical (pain frequency, pain severity, nonpain symptoms) and psychosocial; physical and psychosocial scores are combined to create an overall HRQOL score. Increasing scores (0 to 1) represent increasing HRQOL. Fifty-five patients with CM-I (mean age 12 ± 4 years, 53% male) were enrolled and completed the CHIP and Health Utilities Index Mark 3 (HUI3). Twenty-five healthy controls (mean age 11.9 ± 4 years, 40% male) also completed the CHIP. CHIP scores were compared between these groups via the Mann-Whitney U-test. For CHIP discriminative function, subscore versus presence of CM-I was compared via receiver operating characteristic curve analysis. CHIP scores in the CM-I group were stratified by symptomatology (asymptomatic, headaches, and paresthesias) and compared via Kruskal-Wallis test with Mann-Whitney U-test with Bonferroni correction (p < 0.0167). CHIP was compared with HUI3 (Health Utilities Index Mark 3) via univariate and multivariate linear regression. RESULTS CHIP physical and psychosocial subscores were, respectively, 24% and 18% lower in CM-I patients than in controls (p < 0.001); the overall HRQOL score was 23% lower as well (p < 0.001). The area under the curve (AUC) for CHIP physical subscore versus presence of CM-I was 0.809. CHIP physical subscore varied significantly with symptomatology (p = 0.001) and HUI3 pain-related quality of life (R(2) = 0.311, p < 0.001). The AUC for CHIP psychosocial subscore versus presence of CM-I was 0.754. CHIP psychosocial subscore varied significantly with HUI3 cognitive- (R(2) = 0.324, p < 0.001) and emotion-related (R(2) = 0.155, p = 0.003) quality of life. The AUC for CHIP HRQOL versus presence of CM-I was 0.820. Overall CHIP HRQOL score varied significantly with symptomatology (p = 0.001) and HUI3 multiattribute composite HRQOL score (R(2) = 0.440, p < 0.001). CONCLUSIONS The CHIP is a patient-reported, CM-I-specific HRQOL instrument, with construct validity in assessing pain-, cognitive-, and emotion-related quality of life, as well as symptomatic features unique to CM-I. It holds promise as a discriminative HRQOL index in CM-I outcomes assessment.
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Travis R
authors.initials: TR
authors.lastname: Ladner
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Ashly C
authors.initials: AC
authors.lastname: Westrick
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: John C
authors.initials: JC
authors.lastname: Wellons
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Chevis N
authors.initials: CN
authors.lastname: Shannon
mesh_terms: D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D011594:Psychometrics / Q000295:instrumentation*; D011788:Quality of Life; D015203:Reproducibility of Results; D012720:Severity of Illness Index
keywords: AUC = area under the curve; CCOS = Chicago Chiari Outcomes Scale; CHIP = Chiari Health Index for Pediatrics; CM-I = Chiari Type I; Chiari Health Index for Pediatrics; Chiari Type I malformation; HOQ = Hydrocephalus Outcomes Questionnaire; HRQOL = health-related quality of life; HUI3 = Health Utilities Index Mark 3; PedsQL 4.0 = Pediatric Quality of Life Inventory 4.0; ROC = receiver operating characteristic; SF-10 = SF-10 Health Survey for Children; quality of life