Neuropsychiatric Disease and Treatment (Nov 2022)
The ESSENCE-Questionnaire in Medical Records Screening for Neurodevelopmental Symptoms/Problems: Utility and Clinical Validity
Abstract
Valdemar Landgren,1,2 Zohar Raanan Soltis,1 Emma Svensson,3 Michail Theodosiou,2,4 Magnus Landgren,2 Rajna Knez2,5 1Department of Psychiatry, Skaraborg Hospital, Skövde, Sweden; 2Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 3Department of Child Psychiatry, Skaraborg Hospital, Skövde, Sweden; 4School Health Services, City of Gothenburg, Gothenburg, Sweden; 5Department of Pediatrics, Skaraborg Hospital, Skövde, SwedenCorrespondence: Valdemar Landgren, Department of Psychiatry, Skaraborg Hospital Skövde, Lövängsvägen, Skövde, 541 45, Sweden, Tel +46702960450, Email [email protected]: Determine the prevalence of symptoms of neurodevelopmental problems (NDPs) with a semi-structured review of fourth grade students’ medical records, its interrater agreement and validity as compared with clinical assessment.Methods: A school-based sample of 11-year-old children provided child health care (CHC) records and school health care (SHC) records. A pediatric neurologist, child psychiatrist and an adult psychiatrist scored the records, with the “Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations-Questionnaire” (ESSENCE-Q, 12 items scored 0– 2, summary score range 0– 24). Agreement was measured with model-based kappa and intraclass correlation coefficient (ICC). Ratings were validated against a multidisciplinary assessment involving a physician, psychologist, teacher- and parental behavioral rating scales rendering a clinical global impression severity rating (CGI-S, range 1– 7) of NDPs.Results: Out of 223 participants, medical charts were available from 201, of whom 169 were rated by all three raters. Kappa agreement was moderate/strong (~0.8) for 7 of the 12 questionnaire items. Measured with the ICC, concordance in the summary score was good for agreement (~0.8) and excellent (~0.9) for consistency. Test–retest reliability was excellent (ICC = ~0.9). Area under the curve for the ESSENCE-Q in predicting clinical-level problems (CGI ≥ 4) was ~80% for all three raters, albeit with differing optimal cutoffs.Conclusion: Using the ESSENCE-Q as a template, NDPs appear to be common in medical records, are identified reliably, and predict clinical-level concern. Medical records screening may facilitate a structured review of medical records in work-ups or be applied in conjunction with other screening measures for neurodevelopmental disorders. However, differences in calibration currently preclude defining a universal cutoff for using the ESSENCE-Q for medical records screening.Keywords: neurodevelopmental disorders, medical records, abnormal development, child health, ESSENCE
