Choosing the right outcomes

Outcome measures are used to monitor the effects of interventions in clinical practice or in formal clinical trials. They may also be used to assess changes within populations either spontaneously or as a result of public-health measures. They are used to monitor the course of illness as part of a management plan or, for larger groups, to identify changes brought about, for instance, by migration or immunization. The choice of outcome measure depends on the age of the child, the complexity of the outcome (for instance, whether its application is to individuals or populations), and the time scale over which it is necessary to detect changes in outcome. The most commonly used outcome measures are clinical symptoms, which are often compiled into scoring systems. Surprisingly, these are often the least well-validated measures of outcome. Physiologic measures, although well validated, are difficult to apply to infants and pre-school children. The role of inflammatory markers is currently limited to research rather than clinical practice. Other outcome measures such as quality of life, impact-of-asthma instruments, and measures to determine the health-economic aspects of asthma are poorly developed in childhood. The right outcome depends on the question being asked, the age of the subjects, and the time scale and complexity over which measurement is required.