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International Journal of Epidemiology 2000;29:113-117
© International Epidemiological Association 2000

Factors that determine the effectiveness of screening for congenital heart malformations at child health centres

Rikard E Juttmanna, John Hessb, Caspar WN Loomana and Paul J van der Maasa

a Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
b Department of Paediatric Cardiology, the Sophia Children's Hospital and Erasmus University, Rotterdam, The Netherlands.

Reprint requests to: RE Juttmann, Department of Public Health, Erasmus University Rotterdam, Room EE 2008, PO Box 1738, 3000 DR Rotterdam, The Netherlands. E-mail: juttmann{at}mgz.fgg.eur.nl

Background The actual yield from current screening for clinically significant congenital heart malformations in Dutch child health care is far from optimal. In this study factors that determine the effectiveness of this screening are identified and recommendations for the optimization of the screening programme are formulated.

Methods Eighty-two patients with a clinically significant congenital heart malformation were consecutively included in this study. Parents and child health centre physicians were interviewed in order to establish the screening, detection and referral history. Paediatric cardiologists established whether these patients were diagnosed ‘in time’ or ‘too late’.

Results Incomplete performance of the screening examination has more influence on the occurrence of delayed diagnoses than failure by parents to adhere to the complete visit schedule. Adequate screening advances detection of congenital heart malformations. Severity, however, is the most predominant determinant of the age at referral and diagnosis, as well as of the risk of complications. In only 7 out of 39 patients diagnosed ‘too late’, could no avoidable cause for an adverse outcome be found. In 10 cases (25%) there was a prolonged interval between first referral and diagnosis.

Conclusion To optimize the yield of the screening programme, improvement in the performance of the child health centre physicians and the co-operation of other physicians involved in reducing the interval between referral and diagnosis are required. Thus a considerable improvement in the prevention of complications of congenital heart malformations can be obtained.

Keywords Screening, congenital heart malformation, child health care

Accepted 15 July 1999


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