Jornal de Pediatria (Apr 2009)
Comparação entre avaliação objetiva e autoavaliação da maturação sexual em crianças e adolescentes Comparison between objective assessment and self-assessment of sexual maturation in children and adolescents
Abstract
OBJETIVO: Avaliar as correlações entre avaliação objetiva e autoavaliação em ambientes diferentes (ambulatorial e escolar). MÉTODOS: Trezentos e dezenove indivíduos, 178 ambulatoriais (96 meninos e 82 meninas) e 141 (73 meninos e 68 meninas) de escolas públicas (8,3-18,7 anos), com 73 indivíduos (39 meninas e 34 meninos) apresentando índice de massa corporal acima do percentil 85 do Centers for Disease Control and Prevention, de 2000. Todos foram examinados, após consentimento informado, em sequência e individualmente, por dois médicos treinados, e então submetidos a autoavaliação, utilizando fotogramas (Tanner). Dos dados obtidos foram calculados os coeficientes de correlação de kappa entre examinadores e a autoavaliação. Para os testes foi adotado p OBJECTIVE: To assess the correlations between objective assessment and self-assessment of sexual maturation in the outpatient and school settings. METHODS: Three hundred and nineteen individuals, 178 (96 boys and 82 girls) from an outpatient clinic and 141 (73 boys and 68 girls) from public schools (8.3-18.7 years), of whom 73 individuals (39 girls an d 34 boys) had a body mass index above the 85th percentile, according to 2000 CDC Growth Chart, were analyzed. All of them were examined sequentially and individually by two trained physicians after a written consent form was signed by parents or surrogates, and then submitted to self-assessment using pictures (Tanner stages). Kappa coefficients between examiners and the self-assessment were calculated based on the collected data. A p value < 5% was established as statistically significant. RESULTS: No significant difference was observed between correlations obtained from the outpatient clinic and schools, and both groups were combined for analysis. The correlations obtained by examiners were significantly higher than those from self-assessment, with a kappa coefficient (and confidence interval) of 0.75 (0.8-0.69) for breasts/genitals across examiners against 0.27 (0.34-0.20) and 0.29 (0.36-0.22) between the two examiners and the self-assessment (p < 0.0001). CONCLUSIONS: In the studied sample, self-assessment of the pubertal stage should not replace the objective assessment made by trained professionals. Improvement of the self-assessment method may validate its use in population-based studies.
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