Diagnosing daytime bladder symptoms in children with nocturnal enuresis: a comparison of brief parental questionnaire with in-depth, physician-elicited, assessment

Premala Sureshkumar, Patrina H Y Caldwell, Jonathan C Craig
Journal of Paediatrics and Child Health 2010, 46 (11): 636-41

AIMS: To assess the accuracy of brief parental questionnaire reporting of daytime bladder symptoms in children with nocturnal enuresis and compare with in-depth reporting elicited by physician assessment, for diagnosing monosymptomatic and non-monosymptomatic nocturnal enuresis.

METHODS: A cross-sectional study of consecutive children attending an outpatient nocturnal enuresis clinic at a tertiary paediatric hospital participated in the study. Parents were asked to complete a questionnaire as part of routine assessment at their first visit which was compared with a detailed clinical assessment by the physician involving eliciting a thorough history from the parent and child.

RESULTS: Parents of 585 children participated in the study (mean age 9.2 years, range 5.0-17.5 years). Sixty percent of children were males. There was poor agreement between initial parental reporting and physician diagnosis of monosymptomatic and non-monosymptomatic nocturnal enuresis (Kappa = 0.3, 95% confidence interval 0.21-0.37), mainly because parents underreport daytime incontinence and urgency compared with physician-elicited information (43% vs. 69% and 66% vs. 87%, respectively).

CONCLUSIONS: Parents underreport daytime symptoms by 20-25%. Reliance on a brief parental history without prompting by physicians for daytime symptoms for diagnosing type of nocturnal enuresis may be misleading and result in suboptimal management.

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