Background

Pediatric pulmonologists report asthma and obstructive bronchitis in medical records in a variety of ways, and there is no consensus for standardized reporting.

Objective

We investigated which diagnostic labels and features pediatric pulmonologists use to describe obstructive airway disease in children and aimed to reach consensus for standardized reporting.

Methods

We obtained electronic health records from 562 children participating in the Swiss Pediatric Airway Cohort from 2017 to 2018. We reviewed the diagnosis section of the letters written by pediatric pulmonologists to referring physicians and extracted the terms used to describe the diagnosis. We grouped these terms into diagnostic labels (eg, asthma) and features (eg, triggers) using qualitative thematic framework analysis. We also assessed how frequently the different terms were used. Results were fed into a modified Delphi process to reach consensus on standardized reporting.

Results

Pediatric pulmonologists used 123 different terms to describe the diagnosis, which we grouped into 6 diagnostic labels and 17 features. Consensus from the Delphi process resulted in the following recommendations: (i) to use the diagnostic label “asthma” for children older than 5 years and “obstructive bronchitis” or “suspected asthma” for children younger than 5 years; (ii) to accompany the diagnosis with relevant features: diagnostic certainty, triggers, symptom control, risk of exacerbation, atopy, treatment adherence, and symptom perception.

Conclusion

We found great heterogeneity in the reporting of obstructive airway disease among pediatric pulmonologists. The proposed standardized reporting will simplify communication among physicians and improve quality of research based on electronic health records.

中文翻译：

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儿童阻塞性气道疾病报​​告的标准化：国家德尔菲过程

背景

儿科肺科医生在病历中报告哮喘和阻塞性支气管炎的方式多种多样，标准化报告尚无共识。

客观的

我们调查了儿科肺科医生使用哪些诊断标签和特征来描述儿童阻塞性气道疾病，旨在就标准化报告达成共识。

方法

我们获得了 2017 年至 2018 年参加瑞士儿科气道队列的 562 名儿童的电子健康记录。我们审查了儿科肺科医生写给转诊医生的信件中的诊断部分，并提取了用于描述诊断的术语。我们使用定性主题框架分析将这些术语分组为诊断标签（例如，哮喘）和特征（例如，触发器）。我们还评估了不同术语的使用频率。结果被输入到经过修改的德尔菲流程中，以就标准化报告达成共识。

结果

儿科肺科医生使用 123 个不同的术语来描述诊断，我们将其分为 6 个诊断标签和 17 个特征。德尔菲过程的共识产生了以下建议：(i) 对 5 岁以上的儿童使用“哮喘”诊断标签，对 5 岁以下的儿童使用“阻塞性支气管炎”或“疑似哮喘”；(ii) 伴随诊断的相关特征：诊断确定性、触发因素、症状控制、恶化风险、特应性、治疗依从性和症状感知。

结论

我们发现儿科肺科医生在报告阻塞性气道疾病时存在很大的异质性。拟议的标准化报告将简化医生之间的沟通，并提高基于电子健康记录的研究质量。