Improving the rigour of VACTERL screening for neonates with anorectal malformations
Improving the rigour of VACTERL screening for neonates with anorectal malformations
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DOI：
10.1007/s00383-017-4094-3
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发表时间：
2017-05
影响因子：
1.8
通讯作者：
R. England;B. Eradi;G. Murthi;J. Sutcliffe
中科院分区：
文献类型：
--
作者：
R. England;B. Eradi;G. Murthi;J. Sutcliffe
目的：对新生儿肛肠畸形（ARMs）进行椎体、肛肠、心脏、气管-食管、肾脏和肢体（VACTERL）相关性的筛查调查，是处理新生儿肛肠畸形（ARMs）的重要组成部分。我们制定了一个形式来定义调查和转诊指征。当前研究的目的是确定形式是否可以提高筛选的严谨性。方法4个中心对新生儿ARM进行了3年回顾性审计。在引入形式表格后，在接下来的2年中，对连续的新生儿前瞻性地收集相同的数据。定义了VACTERL关联的每个组成部分的适当调查和每个异常结果所需的相应转诊。接受适当调查和转诊的患者比例与这些标准进行比较。每个标准的审计标准为90%。结果实施形式审计前，86例患者接受了审计，实施形式审计后，69例患者接受了审计。在采用形式会计之前，有7项标准符合审计标准，而在采用形式会计之后，有10项标准符合审计标准。结论引入形式表后，VACTERL筛查的完整性和文献记录得到了提高。性能仍不完美。审查具体标准（如椎体筛查的定义）将有助于解决这一问题。
PurposeScreening investigations for the vertebral, anorectal, cardiac, tracheo-oesophageal, renal and limb (VACTERL) association form an important part of the management of neonates with anorectal malformations (ARMs). We developed a proforma to define investigations and indications for referral. The aim of the current study was to determine if the proforma could improve screening rigour.MethodsFour centres performed a 3-year retrospective audit of neonates with ARM. Following introduction of a proforma, the same data were collected prospectively for consecutive neonates over a further 2 years. The appropriate investigation of each component of the VACTERL association and the corresponding referral required for each abnormal result were defined. The proportion of patients undergoing appropriate investigation and referral was compared against these standards. An audit standard of 90% was set for each criteria.ResultsPrior to implementation of the proforma, 86 patients were audited, with a further 69 patients after. The audit standard was met in 7 criteria before introduction of the proforma in comparison to 10 criteria afterwards.ConclusionThe completeness of VACTERL screening and its documentation improved following introduction of the proforma. Performance remains imperfect. Review of specific criteria (such as definition of vertebral body screening) will help address this.