Okul Öncesi Çağı Astımlı "Türk Çocuklarında Çocuklar Için Solunum ve Astım Kontrol Testi (ÇİSAKT)'nin" Geçerlilik, Güvenilirlik ve Değişime Duyarlılığı

Test for Respiratory and Asthma Control in Kids (TRACK)? questionnaire is the first to measure both the risk and impairment domains of the current guidelines in preschool children. We aimed to measure the reliability, validity, responsiveness, and minimally important difference of the Turkish version of the TRACK questionnaire. A total of 268 children with a mean (±standard deviation) age 2.44 (±1.08) years were included in the study. Caregivers filled in three TRACK questionnaires at enrollment, 1st month, and 3rd month. At each visit, physicians determined the control level and the treatment step based on the GINA guideline recommendations. The internal consistency reliability of the Turkish version of the TRACK questionnaire was found to be 0.74, 0.74, and 0.76 at each of the three visits, respectively (reliability statistics, Cronbach?s ?). There was a significant difference between the mean TRACK scores of the patients in different asthma control status categories (p<0.001). The test-retest reliability was found 0.90. The optimal cut-off scores, according to the Youden index, for ?controlled? and ?poorly controlled? asthma, were 80 and 60 points, respectively. Responsiveness analyze revealed that both at the 2nd and 3rd visits, the mean TRACK score changes were significantly different between the groups (both p<0.001). TRACK scores increased in parallel with improved physician disease control ratings. The Turkish version of the TRACK is an accurate and reliable tool for assessing asthma control status among preschool Turkish children. Its widespread use may help physicians correctly assess control levels among children.Çocuklar için Solunum ve Astım Kontrol Testi (ÇİSAKT)? anketi güncel astım rehberlerinin risk ve bozulma alanlarını ölçen okul öncesi çocuklar için geliştirilmiş ilk ankettir. Bu çalışmanın amacı ÇİSAKT anketi Türkçe versiyonunun adaptasyon, geçerlilik, güvenilirlik ve klinik olarak anlamlı ?en küçük önemli fark?ının araştırılmasıdır. Çalışmaya ortalama (±standart sapma) yaşı 2.44 (± 1.08) yıl olan 268 çocuk alındı. Ebeveynleri tarafından kliniğe başvurduklarında ve takip eden birinci ve üçüncü ayda olmak üzere üç kez ÇİSAKT anketi dolduruldu. Bu üç vizitin her birinde hastaların hekimleri tarafından GINA rehberi önerileri doğrultusunda hastalık kontrol seviyeleri ve tedavi basamakları değerlendirildi. Güvenilirlik analizlerinde Cronbach ? değerleri her üç vizitte sırasıyla 0.74, 0.74, and 0.76 olarak bulundu. Ayırt edici geçerlilikte, rehbere-dayalı hekim kontrol değerlendirmesiyle; kontrollü, kısmi kontrollü ve kötü kontrollü olarak sınıflanan hastaların ortalama ÇİSAKT puanları farklıydı (p<0.001). Test-tekrar test güvenilirliği 0.90 olarak saptandı. ?Kontrollü? ve ?kötü kontrollü? hastaları en iyi ayırt eden kesim noktası Youden indeksiyle sırasıyla 80 ve 60 puan olarak bulundu. Değişime duyarlılık analizinde, hekim kontrol değerlendirmesinde takip vizitlerinde görülen değişimlere ÇİSAKT puanında görülen değişimlerin cevabı paralel bulundu (p<0.001). ÇİSAKT anketinin Türkçe versiyonu okul öncesi çocuklarda astım kontrolünü değerlendirmede kullanılabilecek güvenli ve geçerli bir araçtır. Günlük pratikte yaygın olarak kullanılması hekimlere astım kontrol düzeylerini belirlemede yardımcı olacaktır

Over restrictive elimination of foods in children with food allergy

Background. Previous studies demonstrated critical deficits in diagnosis and management of childhood food allergy (FA), and recent developments in FA research support adopting a proactive approach in FA management. Our objective was to describe FA knowledge and management patterns of pediatricians. Method. We applied a 24-item survey to 170 general pediatricians, pediatric allergists and pediatric gastroenterologists practicing in Turkey. Results. Some IgE-mediated symptoms of FA such as cough, urticaria, wheezing and anaphylaxis were falsely recognized as symptoms of non-IgE-mediated FA by 30%, 29%, 25% and 19% of the participants, respectively. By contrast, 50% of the participants falsely recognized bloody stool, a finding of IgE-mediated FA. Most frequently and least frequently used diagnostic tools were specific IgE (30.5%) and oral food challenge test (1.7%), respectively. Maternal diet restrictions and infant diet restrictions were advised by 82% and 82%, respectively. Percentages of physicians eliminating only 1 food were 21%, 19%; 2 foods were 15%, 11%; 3 foods were 7%, 8%; 4-5 foods were 8%, 11%; 5 to 10 foods were 21%, 26%; and >10 foods were 28%, 25% from the maternal and infant diet, respectively. Cow’s milk, cheese, butter, yoghurt, baked milk products and hen’s egg were the most commonly restricted items. Conclusion. Overall, FA knowledge of pediatricians was fair. Pediatricians utilize an overly restrictive approach when advising diet eliminations in FA. Recent developments favor a more proactive approach to induce immune tolerance and need to be encouraged in pediatric clinical practice. Future educational efforts should focus on emphasizing the deleterious effects of injudicious and extensive eliminations

Predicting Hospitalization in Children with Acute Asthma

Background: Acute asthma is one of the most common medical emergencies in children. Appropriate assessment/treatment and early identification of factors that predict hospitalization are critical for the effective utilization of emergency services. Objective: To identify risk factors that predict hospitalization and to compare the concordance of the Modified Pulmonary Index Score (MPIS) with the Global Initiative for Asthma (GINA) guideline criteria in terms of attack severity. Methods: The study population was composed of children aged 5-18 years who presented to the Emergency Departments (ED) of the tertiary reference centers of the country within a period of 3 months. Patients were evaluated at the initial presentation and the 1st and 4th hours. Results: Of the 304 patients (median age: 8.0 years [interquartile range: 6.5-9.7]), 51.3% and 19.4% required oral corticosteroids (OCS) and hospitalization, respectively. Attack severity and MPIS were found as predicting factors for hospitalization, but none of the demographic characteristics collected predicted OCS use or hospitalization. Hospitalization status at the 1st hour with moderate/severe attack severity showed a sensitivity of 44.1%, specificity of 82.9%, positive predictive value of 38.2%, and negative predictive value of 86.0%; for MPIS >= 5, these values were 42.4%, 85.3%, 41.0%, and 86.0%, respectively. Concordance in prediction of hospitalization between the MPIS and the GINA guideline was found to be moderate at the 1st hour (kappa = 0.577). Conclusion: Attack severity is a predictive factor for hospitalization in children with acute asthma. Determining attack severity with MPIS and a cut-off value >= 5 at the 1st hour may help physicians in EDs. Having fewer variables and the ability to calculate a numeric value with MPIS makes it an easy and useful tool in clinical practice. (C) 2013 Elsevier Inc

PREDICTING HOSPITALIZATION IN CHILDREN WITH ACUTE ASTHMA

Background: Acute asthma is one of the most common medical emergencies in children. Appropriate assessment/treatment and early identification of factors that predict hospitalization are critical for the effective utilization of emergency services. Objective: To identify risk factors that predict hospitalization and to compare the concordance of the Modified Pulmonary Index Score (MPIS) with the Global Initiative for Asthma (GINA) guideline criteria in terms of attack severity. Methods: The study population was composed of children aged 5-18 years who presented to the Emergency Departments (ED) of the tertiary reference centers of the country within a period of 3 months. Patients were evaluated at the initial presentation and the 1st and 4th hours. Results: Of the 304 patients (median age: 8.0 years [interquartile range: 6.5-9.7]), 51.3% and 19.4% required oral corticosteroids (OCS) and hospitalization, respectively. Attack severity and MPIS were found as predicting factors for hospitalization, but none of the demographic characteristics collected predicted OCS use or hospitalization. Hospitalization status at the 1st hour with moderate/severe attack severity showed a sensitivity of 44.1%, specificity of 82.9%, positive predictive value of 38.2%, and negative predictive value of 86.0%; for MPIS >= 5, these values were 42.4%, 85.3%, 41.0%, and 86.0%, respectively. Concordance in prediction of hospitalization between the MPIS and the GINA guideline was found to be moderate at the 1st hour (kappa = 0.577). Conclusion: Attack severity is a predictive factor for hospitalization in children with acute asthma. Determining attack severity with MPIS and a cut-off value >= 5 at the 1st hour may help physicians in EDs. Having fewer variables and the ability to calculate a numeric value with MPIS makes it an easy and useful tool in clinical practice. (C) 2013 Elsevier Inc