Are we ready for universal school-based asthma screening?: An outcomes evaluation.

Abstract

Asthma is the most common chronic condition of childhood and a common reason for school absenteeism and use of school health services. Unrecognized but symptomatic childhood asthma may be adding to this school burden. To evaluate the effectiveness of school-based asthma screening in identifying children at high risk for unrecognized asthma and facilitating new asthma diagnoses. A controlled trial of school-based asthma screening using mailed parent surveys and medical record review to estimate outcomes of interest, specifically numbers of new asthma diagnoses. Most parents (80%, N = 5116) responded to the asthma screening survey. About 1 in 5 (19.4%, n = 994) parents reported that their children had previously been diagnosed with asthma or reactive airway disease. Letters recommending further evaluation for symptoms suggestive of possible asthma were sent to the parents of 388 children (7.6% of respondents) without known asthma. About half of parents returned postcards stating their intended reaction to the referral recommendation including 52 parents (13.4% of those referred) who thought no further action was necessary. Parent-initiated physician visits occurred in 45 (11.6%) of the 388 referred children. Overall, there were 57 (0.9%, 57/6401) new physician diagnoses of asthma among the screened children in the 6 months following screening: 16 in the referred group and 41 in the group not referred, including 20 in the group whose parents said they had known that their child had asthma, but had no medical record documentation of an asthma diagnosis. The incident asthma diagnosis rate was 1.2% (34/2906; P =.25) in a comparable control group that did not participate in screening. School-based asthma screening did not increase the incident rate of asthma diagnoses in this community. Parents participated in the screening process, but the percentage of referred children with follow-up medical visits was low.