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Persistence and Change in Pediatric Symptom Checklist Scores Over 10 to 18 Months

  • Karen A. Hacker
    Correspondence
    Address correspondence to Karen A. Hacker MD, MPH, Institute for Community Health, Cambridge Health Alliance, 163 Gore Street, Cambridge, Massachusetts 02141.
    Affiliations
    Institute for Community Health (Dr Hacker and Ms Williams) and Department of Quality Management (Ms Myagmarjav), Cambridge Health Alliance, Cambridge, Mass; Department of Biostatistics, Boston University School of Public Health, Boston, Mass (Dr Cabral); and Department of Child Psychiatry, Massachusetts General Hospital, Boston, Mass (Dr Murphy)
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  • Sandra Williams
    Affiliations
    Institute for Community Health (Dr Hacker and Ms Williams) and Department of Quality Management (Ms Myagmarjav), Cambridge Health Alliance, Cambridge, Mass; Department of Biostatistics, Boston University School of Public Health, Boston, Mass (Dr Cabral); and Department of Child Psychiatry, Massachusetts General Hospital, Boston, Mass (Dr Murphy)
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  • Enkhbolor Myagmarjav
    Affiliations
    Institute for Community Health (Dr Hacker and Ms Williams) and Department of Quality Management (Ms Myagmarjav), Cambridge Health Alliance, Cambridge, Mass; Department of Biostatistics, Boston University School of Public Health, Boston, Mass (Dr Cabral); and Department of Child Psychiatry, Massachusetts General Hospital, Boston, Mass (Dr Murphy)
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  • Howard Cabral
    Affiliations
    Institute for Community Health (Dr Hacker and Ms Williams) and Department of Quality Management (Ms Myagmarjav), Cambridge Health Alliance, Cambridge, Mass; Department of Biostatistics, Boston University School of Public Health, Boston, Mass (Dr Cabral); and Department of Child Psychiatry, Massachusetts General Hospital, Boston, Mass (Dr Murphy)
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  • Michael Murphy
    Affiliations
    Institute for Community Health (Dr Hacker and Ms Williams) and Department of Quality Management (Ms Myagmarjav), Cambridge Health Alliance, Cambridge, Mass; Department of Biostatistics, Boston University School of Public Health, Boston, Mass (Dr Cabral); and Department of Child Psychiatry, Massachusetts General Hospital, Boston, Mass (Dr Murphy)
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      Objective

      There are many studies of the Pediatric Symptom Checklist (PSC), but none has followed a naturalistic sample longitudinally. We aimed to examine persistence and change in PSC scores over time in children seen in an ambulatory pediatric setting.

      Methods

      The sample of 1033 patients was PSC screened at 2 consecutive preventive care visits (10 to 18 months apart) in 2 pediatric clinics. Longitudinal analyses were conducted to assess predictors of change in PSC category and score.

      Results

      Approximately 30% of the initially screened population did not return for preventive pediatric care. Those who did not return were significantly more likely to have positive PSC scores than those who returned (8% compared with 4.3%, P < .01). PSC scores were highly stable at visit 2 for those who initially scored negative, but they fluctuated more for those who initially scored positive. After controlling for sociodemographic variables and counseling at either visit, referral at visit 1 (P < .0001) predicted changes in mean PSC scores at visit 2. On average, PSC score decreased 3.2 points among those referred at visit 1 but increased 1.6 points in nonreferred children.

      Conclusions

      This is the first study to document the stability and change in PSC scores in a sample of ambulatory pediatric patients. The statistically significant association between pediatrician referral and improved PSC scores provides evidence for the value of referral in primary care, although the study did not examine the relationship between PSC screening and referral. The high rate of positive scores in children who did not return for follow-up suggests the need for alternative strategies for this population.

      Key Words

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