| Objective:To understand the status of delay in diagnosis of children with congenital heart disease of various diseases,and to explore the factors affecting the delay in diagnosis,so as to provide reference and scientific basis for the government departments to improve and establish prenatal screening system of congenital heart disease and formulate effective prevention and control policies of congenital heart disease in children.Method:From 2017 to 2020,the screening team of Fuwai Yunnan Cardiovascular Disease Hospital took the screening site in some communities of 8 provinces in southwest and northwest China as the research site,and 2,895 CHD children and local medical personnel who were screened and treated in the hospital after diagnosis were investigated.In combination with literature review and reference to domestic and foreign research on influencing factors of delayed diagnosis of children with early onset and other diseases,questionnaires for parents and children were made after expert consultation and pre-experiment modification.Through literature review and consultation with congenital heart disease experts,the time standard of delayed diagnosis of several major diseases of congenital heart disease was determined.The number of severe complex congenital heart disease in the investigation was classified as others.A cross-sectional survey was conducted.After informed consent,investigators were trained to pass the field screening form,electronic medical records during hospitalization,and telephone follow-up visits after discharge to collect information about congenital heart disease,the ability of local medical staff to diagnose children with congenital heart disease and relevant hospital facilities.The information of guardians and families was collected,and the basic information of children,guardians,families and local medical resources in the questionnaire were selected.After quantification,the data were input into software and imported into SPSS for statistical analysis.Statistical description method was used to deal with them,and univariate and multivariate regression analysis methods were used to analyze the relationship between these factors and delayed diagnosis.Univariate regression analysis was performed on 18 suspicious influencing factors,and the variables that were significant in statistics and the profession were finally screened out through the conversion of functional variables.Multivariate regression analysis was used to screen out the relevant factors affecting the diagnosis delay.Analyze relevant results,discuss and draw conclusions.Results:1.General information:2895 valid questionnaires were collected from the telephone survey in this study,and the subjects involved in the study were 8 provinces in China.There were 2617(90.40%)children born in Yunnan.There are 30 ethnic groups,including Han,of which there are 2,009 people(69.40%),The average age of children with congenital heart disease was 8.74+5.29 years old.There were 1258 males(43.45%)and 1637 females(56.54%).The average age of primary guardians is 37.75+8.80 years old.2.Patients with delayed diagnosis:CHD was first found and initially diagnosed in 41.9%of the cases by medical team on-site screening.Among 2,895 children with CHD,1,924 cases(66.4%)were delayed.The mean age of diagnosis and delay time of diagnosis of atrial septal defect were 7.25 years(mean delay of 1.25 years).VSD was diagnosed at a mean age of 4.90 years(mean delay of 4.40 years).Mean age of diagnosis of patent ductus arteriosus 5.80(mean delay 4.80 years)Mean age of diagnosis of Tetraloid Syndrome of Fallot 3.19 years(mean delay 6.32 years)Mean age of diagnosis of pulmonary stenosis 6.38 years(mean delay 6.30 years)Mean age of diagnosis of patent foramen ovale 9.43 years(mean delay 6.43 years)For other complex congenital heart diseases,the mean age of diagnosis was 6.12 years(mean delay 5.93 years).1326 Han children(68.9%)were diagnosed with delayed diagnosis.There were 847 males(44.0%)and 1077 females(55.9%).593 households(30.8%)with registered card;1791(93.0%)of them had their parents as their primary guardians,1026(53.3%)of them had primary school education level or below,and 1609(83.6%)of them were working or farming;1677 guardians(87.2%)had no knowledge of congenital heart disease before diagnosis;1,184 households(61.5%)with annual household income below 20,000 yuan;626 patients(32.6%)had congenital heart disease(cyanosis,squatting,common cold,dyspnea,etc.);289 patients(15.0%)had the confirmed hospital more than 300 km away from home;944(49.1%)of the mothers underwent fetal B-ultrasound screening or four-dimensional ultrasound examination during pregnancy,327(16.9%)of the mothers delivered at township health centers,1048(54.5%)of the mothers delivered at county and city(prefecture)hospitals,and 549(28.5%)of the mothers delivered at home or other places;Only 470 patients(24.4%)were screened for congenital heart disease in neonates in the hospital where the children were delivered.3.The single factor Logistic regression analysis results:With atrial septal defect as a reference,several other conditions besides tetralogy of fallot are risk factors for delay.In addition,the children’s family is registered card household,the children’s guardian occupation type is farming,the diagnosis hospital is far away from home,at home delivery,these are the risk factors for delayed diagnosis of congenital heart disease;For children with basic medical insurance for urban residents,with the guardian for not farmed,professional type,the guardian about congenital heart disease knowledge understanding,annual family income is high,the children used to have children with congenital heart disease symptoms,often visits the hospital and city(county)level is high,the mother during pregnancy had prenatal about congenital heart disease,birth children hospitals in congenital heart disease screening that several factors could reduce the risk of delayed diagnosis in children with.4.The multi-factor logistic regression analysis results:In addition to tetraloid fallot and patent foramen ovale,there were several diseases that delayed the diagnosis of atrial septal defect(ASD).At the same time,the age of the guardian,the parents never suspected that the child has congenital heart disease,the diagnosis hospital is far from home,the mother’s delivery place is at home,are the risk factors for delayed diagnosis.Children and families for inputting tent card door and guardians cultural degree is high,the children had congenital heart disease children with symptoms,often visits the hospital to hospital at or above the county level shall,in the diagnosis of congenital heart disease children do too associated with congenital heart disease before inspection,the mother during pregnancy have done or the four-dimensional ultrasound fetal ultrasound screening,children in municipal hospitals can reduce the risk of delays in the diagnosis of children with congenital heart disease,childbirth.ConclusionThere is a large stock of CHD children in rural communities waiting for active screening.Delayed diagnosis of congenital heart disease was serious(66.4%).The main reasons for the delayed diagnosis of CHD are that the guardians are old,farming,registered and registered,with low educational level,the hospitals with diagnostic ability are far away from home,home delivery,and the absence of fetal B-ultrasound screening during pregnancy.It is suggested that in the future,the training of stethoscope and B-mode ultrasound should be strengthened for primary pediatric cardiologists,the publicity and education of congenital heart disease should be strengthened in rural areas,the screening of neonates with CHD should be popularized,and the screening of neonates with congenital heart disease should be added as a basic public health service item. |
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