Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-19T14:19:51.615Z Has data issue: false hasContentIssue false
  • English
  • Français

Accurate diagnosis of CHD by Paediatricians with Expertise in Cardiology

Published online by Cambridge University Press:  07 June 2017

Hannah C. Jacob ,
Hannah Massey ,
Robert W. M. Yates  and
A. Wilfred Kelsall
Hannah C. Jacob
Affiliation:
School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
Hannah Massey
Affiliation:
School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
Robert W. M. Yates
Affiliation:
Paediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom
A. Wilfred Kelsall*
Affiliation:
Neonatal Intensive Care Unit, Addenbrooke’s Hospital, Cambridge, United Kingdom
*
Correspondence to: A. W. Kelsall, Neonatal Intensive Care Unit, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom. Tel: +01 2232 45151; E-mail: wilf.kelsall@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Paediatricians with Expertise in Cardiology assess children with a full history, examination, and often perform an echocardiogram. A minority are then referred to an outreach clinic run jointly with a visiting paediatric cardiologist. The accuracy of the echocardiography diagnosis made by the Paediatrician with Expertise in Cardiology is unknown.

Materials and methods

We conducted a retrospective review of clinic letters for children seen in the outreach clinic for the first time between March, 2004 and March, 2011. Children with CHD diagnosed antenatally or elsewhere were excluded. We recorded the echocardiography diagnosis made by the paediatric cardiologist and previously by the Paediatrician with Expertise in Cardiology.

Results

The Paediatrician with Expertise in Cardiology referred 317/3145 (10%) children seen in the local cardiac clinics to the outreach clinic over this period, and among them 296 were eligible for inclusion. Their median age was 1.5 years (range 1 month–15.1 years). For 244 (82%) children, there was complete diagnostic agreement between the Paediatrician with Expertise in Cardiology and the paediatric cardiologist. For 29 (10%) children, the main diagnosis was identical with additional findings made by the paediatric cardiologist. The abnormality had resolved in 17 (6%) cases by the time of clinic attendance. In six (2%) patients, the paediatric cardiologist made a different diagnosis. In total, 138 (47%) patients underwent a surgical or catheter intervention.

Discussion

Paediatricians with Expertise in Cardiology can make accurate diagnoses of CHD in children referred to their clinics. This can allow effective triage of children attending the outreach clinic, making best use of limited specialist resources.

Keywords

Echocardiogrampaediatricianexpertisediagnosis
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 6 , August 2017 , pp. 1140 - 1145
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. EUROCAT Prevalence Tables (2012). Retrieved December 10, 2015 from http://www.eurocat-network.eu/accessprevalencedata/prevalencetables Google Scholar
2. Andrews, H, Singh, Y. Review of paediatric cardiology services in district general hospitals in the United Kingdom. Cardiol Young 2016; 26: 528–531.CrossRefGoogle ScholarPubMed
3. Kennedy, I. Learning from Bristol: the report of the public inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984-1995. London, 2001. Retrieved December 8, 2015 from at www.bristol-inquiry.org.uk Google Scholar
4. British Congenital Cardiac Association. Requirements for Provision of Outreach Paediatric Cardiology Services. British Congenital Cardiac Association, London, 2009.Google Scholar
5. Karuppaswamy, V, Kelsall, W. Review of paediatric cardiology services in district general hospitals in the United Kingdom. Arch Dis Child 2009; 94: 327.CrossRefGoogle ScholarPubMed
6. NHS England. Proposed congenital heart disease standards and service specifications. A consultation. Leeds, 2014. Retrieved December 10, 2015 from https://www.england.nhs.uk/2014/09/chd-services/ Google Scholar
7. Massin, MM, Masmoudi, H, Dessy, H, et al. Workload of ambulatory activities in a tertiary paediatric cardiac centre. Arch Cardiovasc Dis 2008; 101: 737–741.Google Scholar
8. Murugan, SJ, Thomson, J, Parsons, JM, Dickinson, DF, Blackburn, ME, Gibbs, JL. New outpatient referrals to a tertiary paediatric cardiac centre: evidence of increasing workload and evolving patterns of referral. Cardiol Young 2005; 15: 43–46.CrossRefGoogle ScholarPubMed
9. Wagstaff, MH, Rigby, ML, Redington, AN. Increasing workload and changing referral patterns in paediatric cardiology outreach clinics: implications for consultant staffing. Heart 1998; 79: 223–224.Google Scholar
10. Thyagarajan, S, Chavan, A, Al-Sabbagh, A, Latifi, S, Kelsall, AW. The provision of cardiology services in a non-cardiac paediatric intensive care unit setting. Arch Dis Child 2010; 95: 1068.Google Scholar
11. Kluckow, M, Seri, I, Evans, N. Echocardiography and the neonatologist. Pediatr Cardiol 2008; 29: 1043–1047.Google Scholar
12. Gibbs, JL. Paediatricians subspecialising in cardiology: clinical governance, maintenance of expertise, and training. Arch Dis Child 2006; 91: 878–879.Google Scholar
13. Saraf, RP, Suresh, P, Maheshwari, S, Shah, SS. Pediatric echocardiograms performed at primary centers: diagnostic errors and missing links!. Ann Pediatr Cardiol 2015; 8: 20–24.Google ScholarPubMed
14. Ward, CJ, Purdie, J. Diagnostic accuracy of paediatric echocardiograms interpreted by individuals other than paediatric cardiologists. J Paediatr Child Health 2001; 37: 331–336.Google Scholar
15. Sackey, AH. Prevalence and diagnostic accuracy of heart disease in children with asymptomatic murmurs. Cardiol Young 2015: 1–5.Google ScholarPubMed
16. Gokmen, Z, Tunaoglu, FS, Kula, S, Ergenekon, E, Ozkiraz, S, Olgunturk, R. Comparison of initial evaluation of neonatal heart murmurs by pediatrician and pediatric cardiologist. J Matern Fetal Neonatal Med 2009; 22: 1086–1091.Google Scholar
17. Longjohn, M, Wan, J, Joshi, V, Pershad, J. Point-of-care echocardiography by pediatric emergency physicians. Pediatr Emerg Care 2011; 27: 693–696.CrossRefGoogle ScholarPubMed
18. Pushparajah, K, Garvie, D, Hickey, A, Qureshi, SA. Managed care network for the assessment of cardiac problems in children in a district general hospital: a working model. Arch Dis Child 2006; 91: 892–895.Google Scholar
19. Anagnostou, K, Messenger, L, Yates, R, Kelsall, W. Outcome of infants with prenatally diagnosed congenital heart disease delivered outside specialist paediatric cardiac centres. Arch Dis Child Fetal Neonatal Ed 2013; 98: F218–F221.Google Scholar
20. Royal College of Paediatrics and Child Health. A framework of competencies for the special interest module in paediatric cardiology. London, 2012. Retrieved December 9, 2015 from http://www.rcpch.ac.uk/system/files/protected/page/Cardiology.pdf Google Scholar