Objective

In integrative traditional Korean medicine, children without abnormalities on medical examination but who frequently experience minor illnesses, fatigue and poor appetite are diagnosed as children with weakness. The Pediatric Weakness Scale (PWS) is a validated questionnaire for assessing pediatric weakness, but no standardized cutoff value exists. This study aimed to develop a validated cutoff value for PWS.

Methods

Parents of children aged 6-9 years were administered a survey to measure PWS, PedsQL? Multidimensional Fatigue Scale (MFS), Korean Child Behavior Checklist (K-CBCL), Korean version of the Children's Eating Behavior Questionnaire (K-CEBQ), child growth indices, frequency of respiratory infections, and average duration of respiratory infections. The correlation between PWS and the results of each survey was analyzed using Pearson's or Spearman's correlation. The differences between the weak and normal groups were compared using independent sample t-tests or Mann-Whitney U tests. Receiver-operating characteristic (ROC) curves for the PWS subscale were generated based on five visceral theories (liver, heart, spleen, lung and kidney). The cutoff value was determined at the point that maximized Youden's index on the ROC curve.

Results

A total of 326 parents participated in the study. In PWS, the liver weakness index was significantly correlated with the MFS, heart weakness index with the K-CBCL, spleen weakness index with the K-CEBQ, lung weakness index with the frequency of respiratory infections, average duration of respiratory infections in the past year, and kidney weakness index with birth weight, height percentile, and weight percentile. Significant differences in each PWS subscale were observed between the weak and normal children. The cutoff values for diagnosing weakness in the liver, heart, spleen, lung and kidney were 4.50, 7.50, 4.50, 4.50 and 4.50, respectively, with sensitivity and specificity reaching up to 84.6% and 82.5%.

Conclusion

The cutoff values for PWS derived from this survey will be a useful tool for diagnosing and assessing pediatric weakness. Please cite this article as: Kim TH, Chae H, Han JH, Bang MR, Chang GT, Lee JY, Lee SH. Cutoff value for Pediatric Weakness Scale for diagnosis of pediatric weakness. J Integr Med. 2026; 24(1):105-114.

Key words: Child, Diagnosis, Deficiency, Questionnaire, ROC curve, Pediatric Weakness Scale