Early diagnosis of extrahepatic biliary atresia in an open-access medical system
Justin Hollon1, Matilda Eide, Gregory Gorman
1Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America. jhollon1@jhmi.edu
Insights
Early diagnosis of biliary atresia (BA) is crucial for infant outcomes. In the Military Health System (MHS), infants with BA are diagnosed promptly, regardless of whether they receive primary care in military or civilian facilities.
Area of Science:
- Pediatric Surgery
- Neonatalaundice Management
- Healthcare Access Research
Background:
- Biliary atresia (BA) is the leading cause of infantile cholestatic jaundice.
- Timely diagnosis and surgical intervention before 60 days of life significantly improve infant outcomes.
- Understanding diagnostic timing within healthcare systems is vital for optimizing care.
Purpose of the Study:
- To determine the age of biliary atresia diagnosis within the Military Health System (MHS).
- To compare diagnostic age based on primary care access models (military vs. civilian).
- To test the hypothesis that military primary care leads to earlier diagnosis due to reduced barriers.
Main Methods:
- Retrospective analysis of Tricare enrollees diagnosed with BA (fiscal years 2004-2008).
- Comparison of diagnostic age using non-parametric tests, Kaplan-Meier curves, and log rank tests.
- Analysis stratified by primary care type, gender, prematurity, and co-occurring anomalies.
Main Results:
- 64 infants with BA were identified; median diagnosis age was 40 days (range 1-189).
- 67% were diagnosed by 60 days, and 80% by 90 days.
- No significant difference in diagnosis age between military (46 days) and civilian (37 days) primary care within MHS.
Conclusions:
- Two-thirds of infants with BA in the MHS are diagnosed before 60 days.
- Diagnosis timing is not influenced by gender, prematurity, or additional anomalies.
- Both military and civilian primary care models within MHS achieve comparable timely biliary atresia diagnoses.
Introduction:
Biliary atresia (BA) is the most common cause of cholestatic jaundice in infancy. Early diagnosis and surgical management, ideally before 60 days of age, result in improved outcomes. We aimed to determine the age at diagnosis of BA in the Military Health System (MHS) and to compare the age at diagnosis by access to care models. We hypothesized that children with BA receiving primary care in military facilities have an earlier age at diagnosis due to decreased economic and access barriers.
Methods:
Data for all Tricare enrollees born in fiscal years 2004-2008 with a diagnosis of BA were extracted from MHS databases. Non-parametric tests, Kaplan-Meier curves and log rank tests compared differences in age at diagnosis by type of primary care facility, gender, prematurity and presence of additional anomalies.
Results:
64 subjects were identified within the five year period. Median age at diagnosis was 40 days [range 1-189], with 67% diagnosed by 60 days and 80% by 90 days. 45 (70%) received civilian primary care within the MHS. There was no difference in the median age at diagnosis between subjects in the MHS with civilian primary care vs. military primary care (37 days [1-188] vs. 46 days [1-189]; p=0.58).
Conclusion:
In the MHS, two-thirds of infants with biliary atresia are diagnosed prior to 60 days of life. Gender, prematurity or presence of additional anomalies do not affect the timing of diagnosis. Civilian and military primary care models within the MHS make timely diagnoses of biliary atresia at equivalent rates.
