评价化脓性汗腺炎在儿科患者中的诊断标准。

Evaluation of Hidradenitis Suppurativa Diagnostic Criteria in Pediatric Patients.

机构信息

Department of Dermatology, University of California, San Francisco.

School of Medicine, University of California, San Francisco.

出版信息

JAMA Dermatol. 2022 Dec 1;158(12):1404-1408. doi: 10.1001/jamadermatol.2022.4564.

DOI:10.1001/jamadermatol.2022.4564

PMID:36287577

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9607937/

Abstract

IMPORTANCE

Hidradenitis suppurativa (HS) is associated with considerable diagnostic delay. Although most patients report adolescent onset, existing HS diagnostic criteria may not adequately capture disease in pediatric populations.

OBJECTIVES

To determine the proportion of physician-diagnosed pediatric patients with HS who met diagnostic criteria, and describe demographics, disease characteristics, and diagnostic patterns among pediatric patients with HS.

DESIGN, SETTING, AND PARTICIPANTS: In this retrospective, cross-sectional study, electronic medical records from 2 sites of a single academic tertiary care center were included. Eligible patients were those born after January 1, 1993, and assigned International Classification of Diseases, Ninth and Tenth Revisions (ICD-9/10) codes for HS (ICD-9 705.83/ICD-10 L73.2) between January 1, 2012, and July 1, 2021. Patients were excluded if they were older than 18 years at diagnosis, had inaccessible diagnostic visit notes, or were unintentionally assigned an HS ICD code.

EXPOSURES

Pediatric patients with HS.

MAIN OUTCOMES AND MEASURES

Fulfillment of diagnostic criteria in pediatric patients with HS.

RESULTS

A total of 297 adolescents with HS were included in the study; 123 patients were female (78.1%), 78 self-identified as Black (26.3%), and 116 self-identified as Hispanic (39.1%). The median (IQR) age at diagnosis was 14.0 (13.0-16.0) years. Documentation from the diagnostic visit demonstrated that 127 (42.8%) patients did not meet all 3 major HS diagnostic criteria. Of these patients, 122 (96.1%) did not meet the recurrence interval criterion (≥2 lesions within 6 months). Overall, 96 patients who did not meet the recurrence interval criterion had documentation from additional visits in the health system; 59 (61.5%) had documentation of 1 or more additional lesions consistent with HS. Review of these additional records demonstrated that 26 of these 59 (44.1%) patients met the recurrence interval criterion after diagnosis, and 44 (74.6%) had recurrent lesions within a 1-year interval (median, 6.5 months; interquartile range, 3.5-12.2 months). Medical chart review was conducted from November 22, 2021, to January 12, 2022. Analysis was conducted from January 12, 2022, to January 15, 2022.

CONCLUSIONS AND RELEVANCE

Overall, 118 (40%) of 297 pediatric patients with HS in this retrospective cross-sectional study did not meet all major diagnostic criteria at the time of diagnosis, largely due to failure to fulfill the 6-month recurrence interval criterion. Future studies are needed to determine the appropriate recurrence interval to facilitate timely diagnosis and promote clinical trial eligibility for pediatric patients with HS.

摘要

重要性

化脓性汗腺炎（HS）与相当大的诊断延迟有关。尽管大多数患者报告发病于青少年时期，但现有的 HS 诊断标准可能无法充分捕捉儿科人群中的疾病。

目的

确定被医生诊断为 HS 的儿科患者中符合诊断标准的比例，并描述儿科 HS 患者的人口统计学、疾病特征和诊断模式。

设计、地点和参与者：在这项回顾性、横断面研究中，纳入了单家学术性三级保健中心的 2 个地点的电子病历。符合条件的患者为 1993 年 1 月 1 日以后出生，并于 2012 年 1 月 1 日至 2021 年 7 月 1 日期间被分配了国际疾病分类，第 9 和第 10 修订版（ICD-9/10）HS 代码（ICD-9 705.83/ICD-10 L73.2）。如果患者在诊断时年龄大于 18 岁、就诊记录无法获取或意外被分配 HS ICD 代码，则将其排除在外。

暴露

患有 HS 的儿科患者。

主要结局和测量

儿科 HS 患者符合诊断标准的情况。

结果

本研究共纳入 297 名患有 HS 的青少年；123 名患者为女性（78.1%），78 名自认为是黑人（26.3%），116 名自认为是西班牙裔（39.1%）。诊断时的中位（IQR）年龄为 14.0（13.0-16.0）岁。诊断就诊记录显示，127 名（42.8%）患者未满足所有 3 项主要 HS 诊断标准。在这些患者中，122 名（96.1%）未满足复发间隔标准（6 个月内≥2 个病灶）。总体而言，96 名未满足复发间隔标准的患者在医疗系统中有其他就诊记录；其中 59 名（61.5%）有 1 个或多个符合 HS 的额外病灶记录。对这些额外记录的审查表明，其中 26 名（44.1%）患者在诊断后符合复发间隔标准，44 名（74.6%）患者在 1 年内（中位数为 6.5 个月；四分位距为 3.5-12.2 个月）出现复发性病灶。医疗记录审查于 2021 年 11 月 22 日至 2022 年 1 月 12 日进行。分析于 2022 年 1 月 12 日至 1 月 15 日进行。