Pattern of congenital heart disease in a developing country tertiary care center: Factors associated with delayed diagnosis.
Pattern of congenital heart disease in a developing country tertiary care center: Factors associated with delayed diagnosis.
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DOI：
10.4103/0974-2069.189125
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发表时间：
2016-09
影响因子：
0.7
通讯作者：
Sadiq M
中科院分区：
文献类型：
--
作者：
Rashid U;Qureshi AU;Hyder SN;Sadiq M
目的：确定儿童各种类型先天性心脏病的诊断延误及其相关因素。在这项观察性研究中，354名先天性心脏病(CHD)患者在获得每个儿童监护人的知情口头同意后，于2015年1月1日至2015年6月30日期间首次来到巴基斯坦拉合尔儿童医院心内科就诊。记录观察对象的人口学特征和各种因素。354名入选儿童(男：女1.7：1)，年龄1~176个月(中位数24个月)，有301例(85.1%)有冠心病延迟诊断(主要是无贫血65.3%)，中位延迟(8个月)。延误的主要因素是首次就诊延误(37.2%)和医护人员延误诊断(22.5%)。其他因素包括延迟转诊到三级护理医院(13.3%)、社会禁忌(13.0%)和经济限制(12.3%)。大多数儿童是在医院外分娩(88.7%)。兄弟姐妹少于两个的儿童(40%)比有两个或更多兄弟姐妹的儿童(60%，P<；0.001)延迟时间更少。大多数患者的先天性心脏病诊断被推迟。多种因素，如缺乏训练有素的保健系统和社会经济限制，是造成延误的原因。有必要在发展中国家建立一个有效的转诊制度，提高公众对这类儿童的早期诊断和管理的认识。
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.