國小學生氣喘篩檢研究－－ISAAC錄影帶問卷和書面問卷之比較

Screening for asthma in six elementary school students: Comparison of the ISAAC video questionnaire with written questionnaire

氣喘是兒童與青少年主要的慢性病，隨著兒童氣喘盛行率的快速增加，學校將面臨照顧氣喘學生的挑戰。本研究之目的在評估和比較ISAAC錄影帶問卷和書面問卷應用於國內小學高年級學生氣喘篩檢實務工作上的可行性及有效性。以台北市和宜蘭縣六所小學四、五、六年級全體學生2575人為對象，採ISAAC錄影帶問卷和書面問卷為篩檢工具進行疑似氣喘學生調查。再隨機選出十分之一接受護理人員確診訪談，並將其結果作為黃金標準，來評估篩檢工具的敏感度和特異度。研究結果發現，ISAAC錄影帶問卷和書面問卷的敏感度和特異度均高於0.80，故兩 者均為良好的篩檢工具。進一步比較這兩種篩檢工具的有效性，發現其敏感度相同(0.84和0.84)；但錄影帶問卷的特異度(0.87和0.81)和Youden's指數(0.71: 0.65)均高於書面問卷；ROC曲線圖也顯示錄影帶問卷比書面問卷略佳(0.856： 0.826)。另外， 比較這兩種問卷所篩選出之疑似氣喘學生和正常學生在人口學特性上的差異，發現縣市、性別、年級和父母教育程度不同，疑似氣喘盛行率也不同。綜合言之，本研究顯示ISAAC錄影帶問卷和書面問卷均為無侵襲性、迅速、簡易、兼具經濟性和有效性的兒童氣喘篩檢工具，可實際應用在國內小學校園氣喘學童照護實務工作之第一步以便及早發現疑似病例。

The prevalence of childhood asthma is growing rapidly; therefore, schools are increasingly faced with the issue of defining their role in the care of children with asthma. The objective of the present study was to assess the effectiveness and feasibility of the International Study of Asthma and Allergies in Childhood (ISAAC) video and written questionnaires for screening childhood asthma. Comparison was also made for these two questionnaires in terms of the sensitivity and specificity. Subjects of this study included 2575 fourth to sixth graders in six primary schools in Taipei City and E-Lan County. Video and written ISAAC questionnaires were completed from September to December 2000. Subsequently, a total of 258 students were randomly selected from the study subjects and were interviewed by qualified pediatrics nurses blinded to the screening results by the questionnaires. Using the interview as a gold standard, the sensitivities of the ISAAC video and written questionnaires were the same (0.84). The specificity of the video questionnaire (0.87) was better than that of the written questionnaire (0.81). Based on the results, we concluded that both the video questionnaire and the written questionnaire showed a fairly good accuracy and provided sufficiently reliable data. These two questionnaires might be used as screening instruments for childhood asthma and incorporated into the physical examination activity at elementary schools.