Health-related quality of life in pediatric minor injury: reliability, validity, and responsiveness of the Pediatric Quality of Life Inventory in the emergency department.

Section of Emergency Medicine, Department of Pediatrics, Children’s Research Institute, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
JAMA Pediatrics (Impact Factor: 4.25). 01/2012; 166(1):74-81. DOI: 10.1001/archpediatrics.2011.694
Source: PubMed

ABSTRACT To evaluate the feasibility, reliability, validity, and responsiveness of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) in the first 2 weeks after pediatric emergency department care of minor injury.
Prospective cohort study.
Pediatric hospital emergency department.
Children and adolescents with minor injury (n = 334).
Child- and parent-reported clinical outcomes and PedsQL scale scores.
The PedsQL had good to excellent internal consistency reliability (α range, 0.73-0.93). For each day that the clinical symptoms persisted, there were consistent decreases in mean health-related quality of life (HRQOL) scores (validity testing). There were significantly greater negative changes in mean HRQOL scores for fractures vs soft-tissue injuries and for lower vs upper extremity injuries. Clinical outcomes categorized as poor had large negative changes in HRQOL not seen in good outcome groups. Distribution-based indicators of change supported good responsiveness (effect sizes for the physical summary score, 0.01-2.44; group differences at follow-up exceeded estimates of the minimal importance difference).
The PedsQL is feasible, reliable, and demonstrates good construct and discriminant validity and responsiveness in measuring short-term outcome after minor injury care in the pediatric emergency department. Assessing short-term outcome from the patient perspective with HRQOL measures may greatly enhance our ability to evaluate the effectiveness of emergency department care.

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    ABSTRACT: Background The purpose of this study was to determine the construct validity of the PedsQL¿ health related quality of life (HRQoL) instrument for use among injured children and to examine the impact of using different modes of administration, including paper and pencil, online and telephone.Methods Two hundred thirty-three participants (aged 0 ¿ 16) were recruited from hospital wards and the emergency department of a pediatric hospital in a large urban center in British Columbia, Canada. Data used to evaluate the construct validity of the PedsQL¿ were collected from participants at the time of seeking injury treatment (baseline) to capture a retrospective measure of pre injury health, and one month post injury. Data used to compare different modes of administration (n¿=¿44) were collected at baseline. To assess construct validity repeated measures analysis of variance (rANOVA) was used to determine whether the PedsQL¿ tool was able to discriminate between patients pre and post injury while investigating possible interaction by category of length of stay in hospital. The impact of different modalities of administering the PedsQL¿ on item responses was investigated using Bland-Altman plots.ResultsrANOVA showed significant differences in PedsQL¿ total score between baseline and one month post injury (p¿<¿.001), and differences in mean total score at one month post injury by category of injury severity (p¿<¿.001). There was also significant interaction by category of injury severity for the change in PedsQL¿ total score from baseline to one month (p¿<¿.001). Pearson¿s correlations were highly significant across three modalities of survey administration: paper and pencil, computer and telephone administration (range: .92 to .97, p¿<¿.001). Bland-Altman plots showed strong consistency.Conclusion The PedsQL¿ instrument is able to discriminate between pre and post injury HRQoL, as well as HRQoL post injury for injuries of varying severity. These findings are an indication that this instrument has good construct validity for the purpose of evaluating HRQoL of injured children. Data collected via paper-pencil, online and telephone administration were highly consistent. This is important as depending on the setting, clinical or research, different modalities of completing this instrument may be more appropriate.
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