Rashid Usman, Qureshi Ahmad U, Hyder Syed N, Sadiq Masood
Department of Pediatric Cardiology, The Children's Hospital and Institute of Child Health, Lahore, Pakistan.
Ann Pediatr Cardiol. 2016 Sep-Dec;9(3):210-5. doi: 10.4103/0974-2069.189125.
To determine the delay in diagnosis of various types of congenital heart defects in children and factors associated with such delay.
For this observational study, 354 patients having congenital heart disease (CHD) presenting for the first time to the Department of Cardiology, Children's Hospital, Lahore, Pakistan, between January 1, 2015 and June 30, 2015, were enrolled after obtaining informed verbal consent from the guardian of each child. Demographical profile and various factors under observation were recorded.
Among the 354 enrolled children (M: F 1.7:1) with age ranging from 1 to 176 months (median 24 months), 301 (85.1%) had delayed diagnosis of CHD (mainly acyanotic 65.3%), with median delay (8 months). Main factors for delay were delayed first consultation to a doctor (37.2%) and delayed diagnosis by a health professional (22.5%). Other factors included delayed referral to a tertiary care hospital (13.3%), social taboos (13.0%), and financial constraints (12.3%). Most children were delivered outside hospital settings (88.7%). Children with siblings less than two (40%) were less delayed than those having two or more siblings (60%, P < 0.001).
Diagnosis of congenital heart defect was delayed in majority of patients. Multiple factors such as lack of adequately trained health system and socioeconomic constraints were responsible for the delay. There is a need to develop an efficient referral system and improve public awareness in developing countries for early diagnosis and management of such children.
确定儿童各类先天性心脏病的诊断延迟情况以及与此类延迟相关的因素。
在本观察性研究中，2015年1月1日至2015年6月30日期间首次前往巴基斯坦拉合尔儿童医院心脏病科就诊的354例先天性心脏病（CHD）患者，在获得每个孩子监护人的口头知情同意后被纳入研究。记录人口统计学资料和观察的各种因素。
在354名年龄为1至176个月（中位数24个月）的纳入儿童中（男∶女为1.7∶1），301例（85.1%）先天性心脏病诊断延迟（主要是非青紫型，占65.3%），中位延迟时间为8个月。延迟的主要因素是首次就医延迟（37.2%）和卫生专业人员诊断延迟（22.5%）。其他因素包括转诊至三级医院延迟（13.3%）、社会禁忌（13.0%）和经济限制（12.3%）。大多数儿童在医院外分娩（88.7%）。兄弟姐妹少于两个的儿童（40%）诊断延迟情况少于有两个或更多兄弟姐妹的儿童（60%，P<0.001）。
大多数患者先天性心脏病的诊断存在延迟。缺乏训练有素的卫生系统和社会经济限制等多种因素导致了延迟。发展中国家需要建立高效的转诊系统并提高公众意识，以便对这类儿童进行早期诊断和管理。
