Tybulewicz A T, Rigby M L, Redington A N
Royal Brompton Hospital, London.
Heart. 1996 Jun;75(6):632-4. doi: 10.1136/hrt.75.6.632.
To evaluate the changing role of an open-access consultant-led paediatric echocardiography service for the detection and assessment of cardiac disease in children.
A retrospective analysis comparing two patient groups undergoing echocardiography over two corresponding six month periods in 1989 and 1994.
A tertiary referral centre.
Patient demographics, indication for echocardiogram, source of referral and findings on scan in new referrals, subsequent follow up arrangements.
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.
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.
评估由顾问主导的开放式儿科超声心动图服务在儿童心脏病检测和评估中不断变化的作用。
对1989年和1994年两个相应的六个月期间接受超声心动图检查的两组患者进行回顾性分析。
一家三级转诊中心。
患者人口统计学资料、超声心动图检查指征、转诊来源以及新转诊患者的扫描结果、后续随访安排。
5年间总工作量增加了51%，但1994年扫描的新生儿数量减少。患者由医院儿科医生、社区儿科医生和全科医生转诊，“新转诊患者”占扫描患者总数的百分比保持不变。因无症状杂音转诊且超声心动图检查结果“正常”的儿童数量增加。1994年直接转诊进行手术的患者减少，但转诊接受介入性心导管检查的儿童数量增加。
尽管当地医院的超声心动图设备越来越多，且当地儿科医生外展诊所的需求增加，但开放式超声心动图在三级转诊中心的作用仍在扩大。无症状杂音仍然是“新患者”转诊的最常见单一原因，许多扫描用于证实临床对“正常”心脏的怀疑。在仅转诊那些存在诊断困难的儿童更合理的情况下，将超声心动图用作筛查程序的适当性值得质疑。尽管如此，这些数据证实了对儿科心脏病专家需求不断增加的印象，因此可能有助于规划该专业内的顾问服务。
