Related Experiment Videos
Screening for congenital heart malformation in child health centres
R E Juttmann1, J Hess, C W Looman
1Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
Insights
Evaluating congenital heart malformation screening in Dutch Child Health Centres (CHC) shows it aids early detection. However, the current screening program
Area of Science:
- Pediatric Cardiology
- Public Health Screening Programs
- Congenital Malformations
Background:
- Congenital heart malformations (CHMs) are a significant concern in pediatric health.
- Evaluations of existing CHM screening programs are scarce.
- This study assesses the effectiveness of CHM screening within the Dutch Child Health Centres (CHC) framework.
Purpose of the Study:
- To evaluate the performance of the current CHM screening process in Dutch CHCs.
- To determine the timeliness of diagnosis in relation to screening.
- To identify areas for improvement in the CHM screening protocol.
Main Methods:
- A 2-year study included 290 pediatric patients (32 days to 4 years) with CHMs at Sophia Children's Hospital, Rotterdam.
- Paediatric cardiologists determined if diagnoses occurred after hemodynamic complications ('too late').
- Interviews with parents and CHC physicians gathered screening and detection history; test properties were calculated.
Main Results:
- The overall screening sensitivity was 0.57, specificity 0.985, and positive predictive value 0.13.
- For adequately screened patients, sensitivity improved to 0.89.
- Adequately screened patients had a significantly lower risk of late diagnosis (17%) compared to inadequately screened patients (48%).
Conclusions:
- CHC screening contributes to earlier detection of congenital heart malformations.
- The current screening program's yield is suboptimal, indicating a need for enhancement.
- Improvements in the screening process are crucial for better patient outcomes.
Background:
Although screening for congenital heart malformations is part of the child health care programme in several countries, there are very few published evaluations of these activities. This report is concerned with the evaluation of this screening at the Dutch Child Health Centres (CHC).
Methods:
All consecutive patients, aged between 32 days and 4 years, presented at the Sophia Children's Hospital Rotterdam throughout a period of 2 years, with a congenital heart malformation were included in this study. Paediatric cardiologists established whether or not these patients were diagnosed after haemodynamic complications had already developed (diagnosed 'too late'). Parents and CHC-physicians were interviewed in order to establish the screening and detection history. Test properties were established for all patients with a congenital heart malformation (n = 290), intended effects of screening were established in patients with clinically significant malformations (n = 82).
Results:
The sensitivity of the actual screening programme was 0.57 (95% CI : 0.51-0.62), the specificity 0.985 (95% CI : 0.981-0.990) and the predictive value of a positive test result 0.13 (95% CI: 0.10-0.19). Sensitivity in a subpopulation of patients adequately screened was 0.89 (95% CI: 0.74-0.96). Adequately screened patients were less likely to be diagnosed 'too late' than inadequately screened patients (odds ratio [OR] = 0.20, 95% CI: 0.04-1.05). The actual risk of being diagnosed 'too late' in the study-population (48%) was only slightly less than the estimated risk for patients not exposed to CHC-screening (58%, 95% CI: 43%-72%). Adequately screened patients however were at considerably less risk (17%, 95% CI: 4%-48%).
Conclusion:
Screening for congenital heart malformations in CHC contributes to the timely detection of these disorders. The actual yield, however, is far from optimal, and the screening programme should be improved.