Diagnosis of asthma in children is not easy as there is no gold standard test for use in children. There have been many research in this regard and asthma predictive index was devised. Having its own limitations its not in use any more. Since last 2 decades the diagnosis of childhood asthma has been empirical based on history clinical acumen and at times response to therapy.
In 21 st century, with growing concerns over overdiagnosis of asthma in children; the diagnosis of asthma is left as diagnosis by exclusion. On the same lines an attempt had been made to device a criteria to exclude diagnosis of asthma. The criteria is labelled as OTA [Other Than Athma] criteria.It is assumed that if a case doesnot satisfy OTA tool, then its likely to be asthma.
This study aims at validation of the OTA criteria tool in excluding diagnosis of asthma by heuristic validation, content and constructive validation and validation by direct application on cases helping one make a more reliable diagnosis of asthma.
The tool is as follows:
A pattern of repeated cough cold or wheezing or breathlessness is considered to be other than asthma; if any of the following issues or patterns exist and may require diagnostic evaluation or therapy before labelling or treating or counselling a patient or child as asthma,.
OTA: STRONG SUSPECT
major criteria: most likely OTA if:
1. if most[50%] episodes come with fever
2. there is early night sleeping time discomfort but no early morning discomfort
3.there is obvious evidence of tonsilitis, adenoiditis, sinusitis, mouth breathing/nose block,foreign body inhalation, REFLUX
4. there is obvious evidence of other chronic disease like heart disease, renal disease, low calcium, microcephaly or failure to thrive or significant neonatal insult or delayed milestones'
5.Radiological evidence of persistant patch 3 months apart or Radiological evidence of specific parenchymal disease SUSPECTminor criteria: may be OTA if:
1.age of onset less than 4 years
2.first episode
3.no family history
4.no known allergy or sensitivity
5.repeatedly treated with antibiotics
6.doesnt respond in 2 weeks to asthma line therapy or symptoms; despite steroid use
7.symptoms lasting months despite any therapy
8.IgE not raised, no eosinophilia
9.spirometry normal
10.xray no hyper inflation
It is proposed that
MINIMUM 'ONE MAJOR CRITERIA AND TWO MINOR CRITERIA' OR 'TWO MAJOR CRITERIA' OR'FOUR MINOR CRITERIA' ARE REQUIRED TO MAKE A DIAGNOSIS OF OTHER THAN ASTHMA.
The tool will be presented as a questionairre in screening asthma in children.
AND IF ITS NOT OTA ITS MOST LIKELY TO BE ASTHMA.
The study is aimed to prove or disprove the OTA tool in diagnosis of asthma.
As this is a novel tool, this will be the first tool to study its validity.
==========================================================
Aim
Validation of OTA screening tool for diagnosis of asthma in children
Objectives
1.Validation of screening tool by expert validation
2.Content and Constructive validation of the OTA tool
3.validation of OTA tool by direct application on patients
=========================================================
Inclusion criteria:
1.all patients presenting to pediatric respiratory clinic at a tertiary care center
2.age group 1 month to 12 years
exclusion criteria
1. hospitalised patients
===========================================================
methods:
after taking Ethics Comittee permission for the study; the tool will be internally validated for its content and construct; taking each parameter into consideration.
Heuristic validation of tool will be carried out by 10 expertspractising in childhood asthma.
external validation:
After EC approval, It is planned to recruit all new cases that present to pediatric respiratory OPD in one year. a written informed consent and assent when needed will be taken from parent and child as applicable.
The tool will be applied through a questionarre to the parents of children presenting to pediatric respiratory clinic.The details needed asper tool and study criteria will be noted; before the working diagnosis of the case is made.
The OTA tool result is compared with the working diagnosis of the case made by the treating doctor on day 1 of visit and day 30 of the visit.
The results will be studied to compare the predictability of OTA tool with clinical diagnosis on day 1 and day 30 of presentation.
The clinical diagnosis after 30 days of presentation is taken as gold standard diagnosis in confirming or ruling out childhood asthma.
===============================================================
Sample size
As this is a novel study, we tend to recruit a maximum of 120 cases over one year.
in our pediatric respiratory clinic, we have at least 200 new cases each year. Of these 50 turnout to be having childhood asthma.So, over an year when 100 cases are enrolled approximately it will have near balanced population of asthma and non asthma cases to be able to perform statistical analysis.
================================================================
Approximate results:
clinical asthma non clinical asthma
OTA n1 n2
Non OTA n3 n4
statistical tests:Sensitivity and specificity of OTA in ruling out childhood asthma or predicting it will be noted,.
==================================================================
references:
http://erj.ersjournals.com/content/48/suppl_60/PA4231
https://www.ncbi.nlm.nih.gov/pubmed/29139062
https://www.ncbi.nlm.nih.gov/pubmed/22022892
https://www.ncbi.nlm.nih.gov/pubmed/15777519
In 21 st century, with growing concerns over overdiagnosis of asthma in children; the diagnosis of asthma is left as diagnosis by exclusion. On the same lines an attempt had been made to device a criteria to exclude diagnosis of asthma. The criteria is labelled as OTA [Other Than Athma] criteria.It is assumed that if a case doesnot satisfy OTA tool, then its likely to be asthma.
This study aims at validation of the OTA criteria tool in excluding diagnosis of asthma by heuristic validation, content and constructive validation and validation by direct application on cases helping one make a more reliable diagnosis of asthma.
The tool is as follows:
A pattern of repeated cough cold or wheezing or breathlessness is considered to be other than asthma; if any of the following issues or patterns exist and may require diagnostic evaluation or therapy before labelling or treating or counselling a patient or child as asthma,.
OTA: STRONG SUSPECT
major criteria: most likely OTA if:
1. if most[50%] episodes come with fever
2. there is early night sleeping time discomfort but no early morning discomfort
3.there is obvious evidence of tonsilitis, adenoiditis, sinusitis, mouth breathing/nose block,foreign body inhalation, REFLUX
4. there is obvious evidence of other chronic disease like heart disease, renal disease, low calcium, microcephaly or failure to thrive or significant neonatal insult or delayed milestones'
5.Radiological evidence of persistant patch 3 months apart or Radiological evidence of specific parenchymal disease SUSPECTminor criteria: may be OTA if:
1.age of onset less than 4 years
2.first episode
3.no family history
4.no known allergy or sensitivity
5.repeatedly treated with antibiotics
6.doesnt respond in 2 weeks to asthma line therapy or symptoms; despite steroid use
7.symptoms lasting months despite any therapy
8.IgE not raised, no eosinophilia
9.spirometry normal
10.xray no hyper inflation
It is proposed that
MINIMUM 'ONE MAJOR CRITERIA AND TWO MINOR CRITERIA' OR 'TWO MAJOR CRITERIA' OR'FOUR MINOR CRITERIA' ARE REQUIRED TO MAKE A DIAGNOSIS OF OTHER THAN ASTHMA.
The tool will be presented as a questionairre in screening asthma in children.
AND IF ITS NOT OTA ITS MOST LIKELY TO BE ASTHMA.
The study is aimed to prove or disprove the OTA tool in diagnosis of asthma.
As this is a novel tool, this will be the first tool to study its validity.
==========================================================
Aim
Validation of OTA screening tool for diagnosis of asthma in children
Objectives
1.Validation of screening tool by expert validation
2.Content and Constructive validation of the OTA tool
3.validation of OTA tool by direct application on patients
=========================================================
Inclusion criteria:
1.all patients presenting to pediatric respiratory clinic at a tertiary care center
2.age group 1 month to 12 years
exclusion criteria
1. hospitalised patients
===========================================================
methods:
after taking Ethics Comittee permission for the study; the tool will be internally validated for its content and construct; taking each parameter into consideration.
Heuristic validation of tool will be carried out by 10 expertspractising in childhood asthma.
external validation:
After EC approval, It is planned to recruit all new cases that present to pediatric respiratory OPD in one year. a written informed consent and assent when needed will be taken from parent and child as applicable.
The tool will be applied through a questionarre to the parents of children presenting to pediatric respiratory clinic.The details needed asper tool and study criteria will be noted; before the working diagnosis of the case is made.
The OTA tool result is compared with the working diagnosis of the case made by the treating doctor on day 1 of visit and day 30 of the visit.
The results will be studied to compare the predictability of OTA tool with clinical diagnosis on day 1 and day 30 of presentation.
The clinical diagnosis after 30 days of presentation is taken as gold standard diagnosis in confirming or ruling out childhood asthma.
===============================================================
Sample size
As this is a novel study, we tend to recruit a maximum of 120 cases over one year.
in our pediatric respiratory clinic, we have at least 200 new cases each year. Of these 50 turnout to be having childhood asthma.So, over an year when 100 cases are enrolled approximately it will have near balanced population of asthma and non asthma cases to be able to perform statistical analysis.
================================================================
Approximate results:
clinical asthma non clinical asthma
OTA n1 n2
Non OTA n3 n4
statistical tests:Sensitivity and specificity of OTA in ruling out childhood asthma or predicting it will be noted,.
==================================================================
references:
http://erj.ersjournals.com/content/48/suppl_60/PA4231
https://www.ncbi.nlm.nih.gov/pubmed/29139062
https://www.ncbi.nlm.nih.gov/pubmed/22022892
https://www.ncbi.nlm.nih.gov/pubmed/15777519
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