Assessing Psychosocial Impairment in the Pediatric Emergency Department: Child/Caregiver Concordance

The objective of this study was to examine the level of agreement between child- and caregiver-reports of the child’s psychosocial problems presenting to a Pediatric Emergency Department (PED) using a validated screening tool. This was an anonymous, prospective, cross-sectional, multi-informant (child and caregiver) study assessing cognitive, emotional, and behavioral problems and physical complaints in children and adolescents presenting to a PED. Three-hundred and fifty-eight children and adolescents (8–18 years old) and their caregivers participated. Children completed the Youth-Pediatric Symptom Checklist (PSC-Y), while their caregivers completed the Pediatric Symptom Checklist–35 (PSC-35) to measure psychosocial impairment. The child’s physical complaints (e.g., chief complaint, chronicity, other medical problems, medications) and demographic information were assessed using an investigator-developed patient background questionnaire completed by the caregivers. Physical complaints (e.g., chief complaint, chronicity, other medical problems, medications) were assessed using an investigator-developed patient background questionnaire. Agreement between child- and caregiver- reports was analyzed using Cohen’s kappa coefficient. Differences between child and caregiver-reported scores were determined by t-tests. Poor to moderate agreement was found between child- and caregiver-reports of attention problems (κ = .355), externalizing problems (κ = .340), internalizing problems (κ = .065), and total PSC score (κ = .410). Both children and caregivers should complete the psychosocial screener to maximize the accuracy of assessment and the identification of impairment.