A medical record review for functional somatic symptoms in children

Rask, Charlotte Ulrikka; Borg, Carsten; Søndergaard, Charlotte; Schulz-Pedersen, Søren; Thomsen, Per Hove; Fink, Per

doi:10.1016/j.jpsychores.2009.10.003

« Previous Next »Journal of Psychosomatic Research
Volume 68, Issue 4 , Pages 345-352, April 2010

A medical record review for functional somatic symptoms in children

Charlotte Ulrikka Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Regional Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Aarhus, Denmark
- Corresponding author. Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerregade 44, DK-8000 Aarhus C, Denmark. Tel.: +45 89494341; fax: +45 89494340.
Carsten Borg
- Department of Paediatrics, Herning Regional Hospital, Herning, Denmark
Charlotte Søndergaard
- Department of Paediatrics, Herning Regional Hospital, Herning, Denmark
Søren Schulz-Pedersen
- Department of Paediatrics, Aarhus University Hospital, Skejby, Aarhus, Denmark
Per Hove Thomsen
- Regional Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Aarhus, Denmark
Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark

Received 16 January 2009; received in revised form 15 September 2009 published online 07 December 2009.

Abstract

Objective

The objectives of this study were to develop and test a systematic medical record review for functional somatic symptoms (FSSs) in paediatric patients and to estimate the inter-rater reliability of paediatricians' recognition of FSSs and their associated impairments while using this method.

Methods

We developed the Medical Record Review for Functional Somatic Symptoms in Children (MRFC) for retrospective medical record review. Described symptoms were categorised as probably, definitely, or not FSSs. FSS-associated impairment was also determined. Three paediatricians performed the MRFC on the medical records of 54 children with a diagnosed, well-defined physical disease and 59 with ‘symptom’ diagnoses. The inter-rater reliabilities of the recognition and associated impairment of FSSs were tested on 20 of these records.

Results

The MRFC allowed identification of subgroups of children with multisymptomatic FSSs, long-term FSSs, and/or impairing FSSs. The FSS inter-rater reliability was good (combined kappa=0.69) but only fair as far as associated impairment was concerned (combined kappa=0.29).

Conclusions

In the hands of skilled paediatricians, the MRFC is a reliable method for identifying paediatric patients with diverse types of FSSs for clinical research. However, additional information is needed for reliable judgement of impairment. The method may also prove useful in clinical practice.

Keywords: Functional somatic symptoms, Medical record review, Inter-rater reliability, Children