Inter-Rater and Test–Retest Reliability of the German Pediatric Evaluation of Disability Inventory (PEDI-G)

ABSTRACT

Activities of daily living (ADL) of children are widely assessed with the Pediatric Evaluation Disability Inventory (PEDI). This study examined test–retest and inter-rater reliability of the German PEDI (PEDI-G). During the adaptation of the PEDI nine items were added. In total, 117 parents of 53 children without and 64 children with a diagnosed physical disability from Austria, Germany, and Switzerland participated. Reliability was examined by intraclass correlation coefficient (ICC), standard error of measurement (SEM) and smallest detectable difference (SDD) for the Functional Skill Scale with and without added items and the Caregiver Assistance Scale. Cohen`s Kappa was used to calculate the reliability of the Modification Scale. All ICC's for test–retest and inter-rater reliability were above 0.75, indicating good to very good reliability. The SDD varied from 0.83–5.58 across PEDI domains and scales. For the Modification Scale, Cohen's weighted kappa varied from 0.25 to 1.00 indicating sufficient reliability for some but not all items. Our findings indicate that the Functional Skill Scale and the Caregiver Assistance Scale of the PEDI-G are reliable scales that can be used to evaluate ADLs of children with and without physical disability.     

Top 3 Differentials in Pediatric Radiology: A Case Review – Rebecca Stein-Wexler (ed)

Indian Journal of Pediatrics -     

Pediatric non-Hodgkin lymphoma: a retrospective 14-year experience with Berlin-Frankfurt-Münster (BFM) protocols from a tertiary care hospital in Serbia

Use of current intensive chemotherapy protocols in pediatric non-Hodgkin lymphoma (NHL) in high-income countries resulted in event-free survival (EFS) rates ranging from 80 to 90%. The results are inferior in less privileged countries with limited resources for medical care. There are no reports about comprehensive data analysis in pediatric NHL in Serbia. A retrospective study was carried out at University Children's Hospital, Belgrade, in children aged less than 18 years diagnosed with non-Hodgkin lymphoma from 1997 to 2011. Fifty-seven children were eligible for analysis. Fourteen were diagnosed with lymphoblastic lymphoma, 38 with mature B-cell NHL (B-NHL), and 5 with anaplastic large-cell lymphoma. Mean age at diagnosis was 9.2 years, with male to female ratio 2.35:1. Children were treated according to Berlin-Frankfurt-Münster (BFM) protocols. With median follow-up of 59.3 months, 5-year probability of EFS was 84.1% for all patients, whereas overall survival was 93%. These results with BFM protocol administration, although inferior to leading international groups, reflect good treatment outcome in our patients. To the best of the authors' knowledge, this article presents the first results regarding treatment and survival of childhood NHL in Serbia.     

Hospitalizations for pertussis in Italy, 1999–2009: analysis of the hospital discharge database

Even if the incidence of pertussis has greatly decreased after the adoption of immunization, it still remains a relevant cause of death in infants in their first years of life. At national level, data are usually greatly underestimated. The objective of this study was to retrospectively review the national hospital discharge form database. The national database was retrospectively searched using the International Classification of Diseases, ninth revision, Clinical Modification system. In the period 1999–2009, 7,768 hospitalizations for pertussis (primary diagnosis) have been registered: 6,971 hospitalizations and 797 day hospital admissions. The annual mean was equal to 633.6 hospitalizations and 72.4 day hospital admissions. The majority of hospitalizations (57.4?%) involved subjects <1?year of age; the mean duration of stay was about 6?days. Conclusion These data, even if restricted to hospitalizations registered at national level, confirm the epidemiological impact of pertussis and its complications in a country with a consistently high vaccination coverage rate.     

Factors Affecting Length of Postoperative Hospitalization for Pediatric Cardiac Operations in a Large North American Registry (1982–2007)

Surgical treatment of congenital heart disease represents a major cause of pediatric hospitalization and healthcare resource use. Larger centers may provide more efficient care with resulting shorter length of postoperative hospitalization (LOH). Data from 46 centers over 25 years were used to evaluate whether surgical volume was an important determinant of LOH using a competing risk regression strategy that concurrently accounted for deaths, transfers, and discharges with some time interactions. Earlier discharge was more likely for infants and older children compared to neonates [subhazard ratios at postoperative day 6 of 1.64 (99 % confidence interval (CI) 1.57, 1.72) and 2.67 (99 % CI 2.53, 2.80), respectively], but less likely for patients undergoing operations in Risk Adjustment for Congenital Heart Surgery categories 2, 3, 4, and 5/6 compared to category 1 [subhazard ratios at postoperative day 6 of 0.66 (99 % CI 0.64, 0.68), 0.34 (95 % CI 0.33, 0.35), 0.28 (99 % CI 0.27, 0.30), and 0.10 (99 % CI 0.09, 0.11), respectively]. There was no difference by sex [non-time-dependent subhazard ratio 1.019 (99 % CI 0.995, 1.040)]. For every 100-operation increase in center annual surgical volume, the non-time-dependent subhazard for discharge was 1.035 (99 % CI 1.006, 1.064) times greater, and center-specific exponentiated random effects ranged from 0.70 to 1.42 with a variance of 0.023. The conditional discharge rate increased with increasing age and later era. No sex-specific difference was found. Centers performing more operations discharged patients sooner than lower volume centers, but this difference appears to be too small to be of clinical significance. Interestingly, unmeasured institutional characteristics estimated by the center random effects were variable, suggesting that these played an important role in LOH and merit further investigation.     

An audit of cancer diagnosis in a Canadian children��s hospital: Quality, timing and efficiency

BACKGROUND AND OBJECTIVE

The diagnosis of paediatric cancer requires multidisciplinary cooperation to achieve both a timely diagnosis and efficient resource use. The authors undertook a 12-month audit of paediatric cancer cases to assess BC’s Children’s Hospital’s (Vancouver, British Columbia) diagnostic process from the perspective of quality (timing and accuracy of diagnosis) and procedural efficiency, with an emphasis on the impact on resource use in the departments of radiology, pathology, anesthesia and surgery.

METHODS

Malignancies (excluding brain and cortical bone primary tumours, for which the preoperative diagnostic workup is often completed before admission) diagnosed between January 1 to December 31, 2003, were reviewed. Data collected included total outpatient versus inpatient procedures, number and timing of diagnostic procedures, general anesthesia (GA) requirements, and lag times from admission to biopsy to diagnosis during the initial hospitalization.

RESULTS

Fifty-four patients were identified. Only 10 patients (19%) had an outpatient diagnostic procedure. One hundred seventeen inpatient diagnostic procedures were performed, with only 50% occurring within regular working hours. Thirty-one per cent of patients required two or more procedural GAs during their initial hospital admission. The mean lag time to biopsy was 2.6 days and to a pathological diagnosis was 1.2 days.

CONCLUSIONS

Despite timeliness, the process of cancer diagnosis at BC Children’s Hospital requires hospital admission and a significant consumption of resources outside of regular working hours. Opportunities for improvement include maximizing outpatient workup, allocating oncology operating room time to increase the percentage of weekday procedures and improving interdisciplinary procedural coordination to reduce the GA requirements per patient.     

Pediatric postmortem computed tomography: initial experience at a children’s hospital in the United States

Pediatric Radiology - Postmortem CT might provide valuable information in determining the cause of death and understanding disease processes, particularly when combined with traditional autopsy....     

Does lack of routine postnatal examination on maternity unit increase the risk of hospital admission in the first week of life?

Objective  

The purpose of this study is to establish whether omitting routine postnatal examination on maternity units increases the risk of hospitalisation in the first week of life of the newborn.     

Practice Variation and Resource Use in the Evaluation of Pediatric Vasovagal Syncope: Are Pediatric Cardiologists Over-Testing?

Syncope is a common problem in children and adolescents. Usually vasovagal in etiology, this benign problem often results in considerable testing and expense. We sought to define the current practice, practice variation, and resource utilization as well as evaluate a screening strategy for syncope at an academic tertiary care center. We reviewed the medical records of all patients age 8 to 19 years who presented with syncope between January 1994 and January 2012 and collected data regarding demographics, history, physical examination, and diagnostic tests. Practice variation was evaluated based on provider experience and subspecialty. The sensitivity and specificity of history, physical examination, and electrocardiogram (ECG) to identify a cardiac cause for syncope were calculated. Of the 617 patients studied, a cardiac cause for syncope was found in 15 (2 %). A screening strategy consisting of history, physical examination, and ECG was 100 % sensitive and 55 % specific for diagnosing a cardiac cause for syncope. Despite having a negative screen, 314 (54 %) patients had a total of 334 additional tests at an average charge of $983/patient. Although practice variation existed, it was not explained by provider experience or electrophysiology training. Factors associated with increased testing included greater number of clinic visits and increased frequency of events, whereas those associated with decreased testing included increased number of syncopal episodes and history of psychiatric medication use. A more standardized approach to syncope is needed to decrease resource use and cost while maintaining quality of care.     

Cost–Benefit Analysis of Providing Fluoride Varnish in a Pediatric Primary Care Office

Introduction

The American Academy of Pediatrics and the U.S. Preventive Services Task Force, among others, call for the provision of fluoride varnish in the pediatric primary care setting, but many barriers exist to the implementation of such a service in this setting. Knowledge of costs and benefits is one such barrier.

Incidence of whooping cough in Spain (1997–2010): an underreported disease

Whooping cough is currently the worst controlled vaccine-preventable disease in the majority of countries. In order to reduce its morbidity and mortality, it is essential to adapt vaccination programmes to data provided by epidemiological surveillance. A population-based retrospective epidemiological study to estimate the minimum annual undernotification rate of pertussis in Spain from 1997 to 2010 was performed. The incidence of pertussis cases reported to the National Notifiable Disease Surveillance System was compared with the incidence of hospital discharges for pertussis from the National Surveillance System for hospital data, Conjunto Mínimo Básico de Datos. The overall reported incidence and that of hospitalisation for whooping cough were 1.3 cases?×?100,000 inhabitants in both cases. Minimum underreporting oscillated between 3.8 and 22.8 %, according to the year of the study. The greatest underreporting (50 %) was observed in children under the age of 1 year. Conclusion: Spanish epidemiological surveillance system of pertussis should be improved with complementary active systems to ascertain the real incidence. Paediatricians and general practitioners should be sensibilized to the importance of notification because this would be essential for adapting the prevention and control measures of this disease.     

Use of alternative–complementary-medicine (CAM) in Calabrian children

Objective

The use of complementary and alternative medicine (CAM) has not been widely studied among children in Italy. ISTAT-2005 survey showed a prevalence of 10% concerning children treated with CAM. The lack of data about the use of CAM in pediatrics in the South of Italy aimed us to conduct an epidemiological inquiry in Calabria.

Methods

The study has been conducted from 2009 and 2011 at the Pediatric Units of: University “Magna Graecia”- Catanzaro (CZ), Pugliese-Ciaccio Hospital-Catanzaro (CZ), Annunziata Hospital-Cosenza (CS), Jazzolino Hospital- ViboValentia (VV), Riuniti Hospitals- Reggio Calabria (RC) and San Giovanni di Dio Hospital- Crotone (KR). All information was collected through a questionnaire proposed to children’s parents admitted to these hospitals as out-patients or in-patients.

Results

1387 parents were approached to complete the questionnaire. 21(1,5%) refused to answer. A total of 1366 questionnaire was analyzed: 378 at CZ , 450 at CS, 131 at KR, 201 at VV and 206 at RC, with a response rate of 98,5%. In total, the percentage of children using CAM varied from 18% in Crotone to 38% in Cosenza. The parents who used CAM for their children were older and with a higher education. Phytotherapy was preferred to homeopathy. The gastrointestinal pathologies and upper respiratory tract are those ones for which frequently parents recur to CAM. Of note we have not to disregard their use “ to strengthen” the immune system. In most of cases CAM have been prescribed by pediatrician.

Conclusions

Our study remarks that the use of CAM is increased dramatically among the calabrian children in the last years as well as in other countries. Pediatricians need to improve their knowledge about CAM in order to better manage the parental attitude.