Harvey Erin, Peterson Eileen, Fee Rachel, Espahbodi Mana, Beste David, Robey Thomas
Department of Otolaryngology and Communication Sciences - Medical College of Wisconsin, Milwaukee, WI, USA.
Medical College of Wisconsin, Milwaukee, WI, USA.
Int J Pediatr Otorhinolaryngol. 2022 Nov;162:111252. doi: 10.1016/j.ijporl.2022.111252. Epub 2022 Jul 22.
PVFMD is a frequent cause of dyspnea in the healthy adolescent. When PVFMD is suspected, the current standard of care includes referral to an otolaryngologist (ENT) prior to beginning laryngeal control therapy (LCT) with a speech language pathologist (SLP). We hypothesize that a "fast-track" screening questionnaire will improve time to treatment and decrease patient charges.
Patients (n = 258, group 1) who received traditional referral and were evaluated in pediatric voice clinic with a diagnosis of PVFMD between 11/2013 and 11/2017 were identified and compared with 66 patients (group 2) from 10/2018 to 11/2019 who were prospectively studied and placed into a fast-tracked subgroup for LCT without preceding ENT evaluation if they scored 8/10 or higher on a designed screening questionnaire.
Female gender (group 1: 81%, group 2: 83%, p = 0.73) and median age (group 1:14 years IQR 4; group 2:14 years IQR 3, p = 0.83) were similar. The median duration from symptom onset to LCT was shorter for group 2 (group 1: 12 months, IQR 18; group 2: 8.5 months, IQR 8)(p = 0.02). Time from referral to LCT was shorter for group 2 at 3 weeks (IQR 3) compared to group 1 at 4 weeks (IQR 3.5, p < 0.01). The minimum single patient charge for group 1 was estimated at $5123 and $1649 for group 2, yielding a potential reduction of charges of over $3000.
Using a fast-track screening questionnaire for pediatric PVFMD patients significantly decreases the time to treatment without altering the response rate of LCT.
阵发性室上性心动过速是健康青少年呼吸困难的常见原因。当怀疑患有阵发性室上性心动过速时，当前的护理标准包括在开始由言语语言病理学家（SLP）进行喉控制治疗（LCT）之前转诊至耳鼻喉科医生（ENT）。我们假设一份“快速通道”筛查问卷将缩短治疗时间并降低患者费用。
确定了2013年11月至2017年11月期间在儿科嗓音诊所接受传统转诊并被诊断为阵发性室上性心动过速的患者（n = 258，第1组），并将其与2018年10月至2019年11月期间的66名患者（第2组）进行比较，后者进行了前瞻性研究，如果他们在一份设计好的筛查问卷中得分8/10或更高，则被纳入快速通道LCT亚组，无需事先接受耳鼻喉科评估。
两组的女性比例（第1组：81%，第2组：83%，p = 0.73）和年龄中位数（第1组：14岁，四分位间距4；第2组：14岁，四分位间距3，p = 0.83）相似。第2组从症状出现到LCT的中位持续时间较短（第1组：12个月，四分位间距18；第2组：8.5个月，四分位间距8）（p = 0.02）。第2组从转诊到LCT的时间为3周（四分位间距3），短于第1组的4周（四分位间距3.5，p < 0.01）。第1组患者的最低单次费用估计为5123美元，第2组为1649美元，潜在费用降低超过3000美元。
使用快速通道筛查问卷对儿科阵发性室上性心动过速患者进行评估可显著缩短治疗时间，且不改变LCT的有效率。
