肛门直肠畸形患儿中低椎体、肛门直肠、心脏、气管食管、肾脏、肢体的筛查率。
Low vertebral ano-rectal cardiac tracheo-esophageal renal limb screening rates in children with anorectal malformations.
作者信息
Lane Victoria A, Ambeba Erica, Chisolm Deena J, Lodwick Daniel, Levitt Marc A, Wood Richard J, Deans Katherine J, Minneci Peter C
机构信息
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio.
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
出版信息
J Surg Res. 2016 Jun 15;203(2):398-406. doi: 10.1016/j.jss.2016.03.056. Epub 2016 Apr 1.
BACKGROUND
The aim of this study was to establish the rate of screening for associated cardiac, vertebral, spinal cord, urologic, and limb anomalies vertebral ano-rectal cardiac tracheo-esophageal renal limb (VACTERL) in children with anorectal malformation (ARM).
METHODS
We performed a retrospective cohort study using the Medicaid Analytic eXtract database which contains enrollment and utilization claims and demographic information from all Medicaid enrollees. Patients born between January 2005 and December 2008 with International Classification of Diseases, Ninth Revision codes for a diagnosis of ARM within 30 days of life, an ARM procedure code during the first year of life, and a minimum of 12 months of continuous enrollment were included. VACTERL screening was determined using International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes for diagnostic tests used to detect these anomalies.
RESULTS
A total of 406 patients were identified (231 males). Evaluation of the spinal vertebrae was performed in 94% of patients (381 of 406). Spinal cord evaluation was performed in 57% (231 of 406): 52% (121 of 231) received spinal ultrasound (US), 24% (56 of 231) received spinal magnetic resonance imaging, and 23% (54 of 231) received both. Sacral radiographs were performed in 8% (32 of 406) and 77% (313 of 406) underwent an echocardiogram. Genitourinary evaluation was performed in 84% (341 of 406): 67% (229 of 341) received renal US, 8% (27 of 341) received abdominal US, and 25% (85 of 341) received both. Limb evaluation was recorded in 19% (76 of 406). Multiple screening including an echocardiogram, spinal radiograph, spinal cord evaluation, and renal evaluation was performed in 45% (181 of 406); 2% (7 of 406) did not receive any screening tests.
CONCLUSIONS
Low VACTERL screening in children with ARM suggests that associated anomalies may be undiagnosed which may lead to increased long-term morbidity.
背景
本研究的目的是确定肛门直肠畸形（ARM）患儿中相关心脏、脊柱、脊髓、泌尿系统及肢体畸形（脊柱、肛门直肠、心脏、气管食管、肾脏、肢体联合畸形，即VACTERL）的筛查率。
方法
我们使用医疗补助分析提取物数据库进行了一项回顾性队列研究，该数据库包含所有医疗补助参保者的登记和使用申请以及人口统计学信息。纳入2005年1月至2008年12月出生、在出生后30天内有国际疾病分类第九版代码诊断为ARM、在出生后第一年内有ARM手术代码且至少连续登记12个月的患者。使用国际疾病分类第九版和当前程序术语代码确定用于检测这些畸形的诊断测试的VACTERL筛查情况。
结果
共确定406例患者（231例男性）。94%的患者（406例中的381例）进行了脊椎评估。57%的患者（406例中的231例）进行了脊髓评估：52%（231例中的121例）接受了脊髓超声检查，24%（231例中的56例）接受了脊髓磁共振成像检查，23%（231例中的54例）两者都接受了。8%的患者（406例中的32例）进行了骶骨X线片检查，77%（406例中的313例）接受了超声心动图检查。84%的患者（406例中的341例）进行了泌尿生殖系统评估：67%（341例中的229例）接受了肾脏超声检查，8%（341例中的27例）接受了腹部超声检查，25%（341例中的85例）两者都接受了。19%的患者（406例中的76例）记录了肢体评估情况。45%的患者（406例中的181例）进行了包括超声心动图、脊柱X线片、脊髓评估和肾脏评估在内的多项筛查；2%（406例中的7例）未接受任何筛查测试。
结论
ARM患儿的VACTERL筛查率较低表明相关畸形可能未被诊断，这可能导致长期发病率增加。
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