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Open-access paediatric echocardiography: changing role and referral patterns to a consultant-led service in a
A T Tybulewicz1, M L Rigby, A N Redington
1Royal Brompton Hospital, London.
Insights
An open-access paediatric echocardiography service saw increased demand, with more referrals for asymptomatic murmurs. This highlights the expanding role of such services in tertiary care and the need for careful patient selection.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Cardiac Disease Assessment
Background:
- The role of open-access consultant-led paediatric echocardiography services is evolving.
- Increasing availability of echocardiography in local settings and outreach clinics presents new challenges.
Purpose of the Study:
- To evaluate the changing role and impact of an open-access paediatric echocardiography service.
- To assess its effectiveness in detecting and evaluating cardiac disease in children over time.
Main Methods:
- Retrospective analysis comparing two six-month periods in 1989 and 1994.
- Data collected from a tertiary referral centre.
- Included patient demographics, referral sources, indications, and scan findings.
Main Results:
- Total echocardiography workload increased by 51% over five years.
- Referrals for asymptomatic murmurs with normal echocardiograms increased.
- Fewer direct surgical referrals, but increased referrals for interventional catheterisation.
Conclusions:
- Open-access paediatric echocardiography plays an expanding role in tertiary centers.
- Asymptomatic murmurs remain a common referral reason, often confirming normal findings.
- Questions arise about using echocardiography as a screening tool; referral of complex cases is more logical.
Objectives:
To evaluate the changing role of an open-access consultant-led paediatric echocardiography service for the detection and assessment of cardiac disease in children.
Design:
A retrospective analysis comparing two patient groups undergoing echocardiography over two corresponding six month periods in 1989 and 1994.
Setting:
A tertiary referral centre.
Main Outcome Measures:
Patient demographics, indication for echocardiogram, source of referral and findings on scan in new referrals, subsequent follow up arrangements.
Results:
The total workload increased by 51% over 5 years but in 1994 fewer neonates were scanned. Patients were referred by hospital paediatricians, community paediatricians, and general practitioners and the number of "new referrals" as a percentage of the total number of patients scanned remained constant. The number of children referred with asymptomatic murmurs who had "normal" echocardiograms increased. Fewer patients were referred directly for surgery in 1994, but the number of children referred for interventional catheterisation rose.
Conclusions:
Open-access echocardiography has an expanding role in the tertiary referral centre despite increasing availability of echocardiography facilities in local hospitals and increased demand in local outreach clinics with paediatricians. Asymptomatic murmurs continue to be the single most common reason for referral of "new patients" and many scans are used to confirm the clinical suspicion of a "normal" heart. The appropriateness of using echocardiography as a screening procedure must be questioned where it would be more logical to refer only the children who present diagnostic difficulty. None the less these data confirm the impression of increasing demands on the paediatric cardiologist, and thus may be useful in planning consultant services within the specialty.