Comparison between objective assessment and self-assessment of sexual maturation in children and adolescents

Abstract

ResumoObjetivo: 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 < 5%. Resultados:Não houve diferença significante entre as correlações obtidas no ambulatório e nas escolas e os dois grupos foram analisados em conjunto. As correlações obtidas entre os examinadores foram significantemente maiores que as da autoavaliação, com kappa (e intervalo de confiança) de 0,75 (0,8-0,69) para mamas/genitália entre examinadores contra 0,27 (0,34-0,20) e 0,29 (0,36-0,22) entre os dois examinadores e a autoavaliação (p < 0,0001).Conclusões: Na amostra estudada, a autoavaliação do estádio puberal não deve substituir a avaliação objetiva feita por profissionais treinados. Um aperfeiçoamento do método de autoavaliação poderia permitir seu uso em estudos populacionais. J Pediatr (Rio J). 2009;85(2):135-142:Puberdade, desenvolvimento sexual, avaliação. AbstractObjective: 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 meth...

Maturational stages: comparison of growth and physical capacity indicators in adolescents

“…although self-evaluated sexual maturation is a valid and widely used method, there is discrepancy in the identification of intermediate stages (II, III and IV), which may result in overestimated information. There are indications of low association between self-evaluation and objective method (performed by specialists) in literature, presenting low agreement between self-evaluation and evaluation performed by specialists 10 . In addition, Fidelix et al 26 suggest that this method may suffer cultural influences regarding stage choices.…”

“…The method of selfevaluated sexual maturation has been considered an easily applicable tool for the estimation of the pubertal stage of children and adolescents, being based on the application of images of the genitalia and pubic hair in a subjective way to individuals 10 . Modulation in the process of sexual maturation is influenced by several changes in the endocrine system, mainly by the activation of the hypothalamicpituitary-gonadal axis that induces the progressive release of androgens, such as testosterone, and by the activation of the hypothalamic-pituitary-ovary axis, which results in the production of estrogen 9,11 .…”

La autoevaluación es un método poco confiable para establecer el desarrollo puberal en escolares

“…El presente estudio tiene como principal fortaleza el gran número de individuos evaluados, lo cual lo diferencia de estudios previamente publicados [3][4][5][6][7] . Por otro lado, la interpretación de los resultados obtenidos es más difícil al no haberse realizado otras mediciones como volumen testicular, palpación y medición de tejido mamario, así como cuestionarios o evaluaciones psicológicas, que apoyen las explicaciones postuladas.…”

“…Sin embargo, los estudios disponibles son escasos y han sido realizados con muestras pequeñas y con resultados dispares [3][4][5][6][7] , En la actualidad no existe un consenso para defi nir que método es el más preciso para realizar la autoevaluación, por lo que esta pregunta no se encuentra contestada aun satisfactoriamente.…”

Dados sociodemográficos, estado nutricional e maturação sexual de escolares do sexo masculino: exposição à insatisfação com a imagem corporal

“…Os escolares recebiam a prancha contendo as figuras e após autoavaliação, assinalavam em qual estágio se encontravam. É importante ressaltar que a literatura evidencia a concordância entre a avaliação médica e a autoavaliação puberal em crianças e adolescentes (AZEVEDO et al, 2009).…”