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Published on: July 3, 2013
Time to referral to a nephrology clinic for pediatric hypertension
Tyler Hamby1,2, Matthew R Pueringer3, Sahil Noorani3
1Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA. Tyler.Hamby@CookChildrens.org.
Insights
Pediatric hypertension diagnosis is often delayed, particularly in obese children. Obese children with elevated blood pressure require more visits and longer referral times to nephrology specialists.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in Children
- Public Health
Background:
- Pediatric hypertension (HTN) rates are rising.
- Adherence to diagnostic criteria for pediatric HTN is not well understood.
- Investigating referral timelines for elevated blood pressure (EBP) in children is crucial.
Purpose of the Study:
- To determine the timeline for referral to nephrology for pediatric patients with elevated blood pressure (EBP).
- To identify predictors of referral time for pediatric EBP.
- To assess adherence to hypertension diagnostic criteria in pediatric care.
Main Methods:
- Retrospective study of 120 patients aged 3-18 years referred for EBP.
- Exclusion criteria: prior referrals, referral for other conditions, or fewer than one prior EBP visit.
- Analysis of sex, age, ethnicity, socioeconomic status, and obesity as predictors of referral time and visit frequency.
Main Results:
- Most patients (68%) had ≥3 prior visits with EBP ≥95th percentile.
- Obesity was a significant predictor: obese children had more EBP visits and longer referral times (p<0.05).
- No other demographic factors predicted referral time or visit frequency.
Conclusions:
- Children with elevated blood pressure are often not referred promptly to nephrology.
- Obese children with EBP experience particular delays in referral.
- Interventions are needed to improve timely referral for pediatric EBP.
Background:
Rates of pediatric hypertension have increased, but adherence to the current diagnostic criteria for hypertension (HTN) in pediatrics is not well known. We investigated the timeline and predictors of time to referral for those referred to nephrology for elevated blood pressure (EBP).
Methods:
A retrospective study was conducted on patients, aged 3-18 years, referred to a nephrology clinic for EBP over a 3-year period. Patients were excluded if they were referred previously, were referred for other conditions, or did not have ≥ 1 prior visit with EBP. Analyses were performed to determine whether sex, age, ethnicity, socioeconomic status, and obesity predicted number of prior visits with EBP and time to referral.
Results:
There were 120 patients (64% male; 53% obese) included and 82 (68%) had ≥ 3 prior visits with EBP ≥ 95%. Medians were as follows: 15.08 years of age at referral; 5 visits with EBP and 3.45 years from first EBP ≥ 90%; 4 visits with EBP and 1.42 years from third EBP ≥ 95%. No variables significantly predicted number of prior visits with EBP or time to referral from the first EBP. Starting with the third EBP ≥ 95%, only obesity significantly predicted number of prior visits and time to referral: Obese patients had more visits (p = 0.01), and took longer to be referred (p = 0.03) than healthy patients.
Conclusion:
Patients with EBP were generally not referred to nephrology promptly, which was especially true for obese patients. Further research is needed to identify interventions to improve time to referral for EBP.
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