A140: Pediatric Rheumatology Admissions in Chile, 2001-2010: Unavailability of a Pediatric Rheumatologist May Hinder a Correct Diagnosis
Authors: Cecilia Poli, Lucía De la Puente, Rodrigo Hoyos-Bachiloglu, Jaime Cerda, Arturo Borzutzky
Journal: Arthritis & Rheumatology (2014)

Background/Purpose:

Pediatric rheumatologic diseases (PRDs) comprise a group of complex conditions that involve considerable disease burden and are sometimes life-threatening. The American College of Rheumatology and the British Society for Pediatric and Adolescent Rheumatology recommend that a Pediatric Rheumatologist (PR) be involved in the care of children affected by PRDs. In Chile, there is a very small group of pediatric rheumatologists; most of them in Santiago. Between years 2000–2010 there were 9 centers in Santiago with a Pediatric Rheumatologist, one in Concepcion (IX Region) and one in Temuco (X Region). Patients living far from a tertiary center with a PR may miss the opportunity of a timely diagnosis and treatment. The purpose of this study was to evaluate trends in PRD admissions in Chile in a 10-year period.



Methods:

We reviewed nationwide admissions due to PRDs in population younger than 18 years between 2001–2010 using national ICD-10 coded hospital discharge databases from the Chilean Ministry of Health. Time trends of PRD admissions were assessed by linear regression. Poisson Rates Ratios were used to compare the rate of admissions for PRDs in centers with and without a PR.



Results:

Of 3,719,124 pediatric admissions, 15,061 (0.4%) had a discharge diagnosis of a PRD. Mean age was 7.9 ± 5 years and 53% were female. Overall lethality rate was 0.2% of admissions. While overall national admissions showed 26.3% of patients had private insurance, among pediatric rheumatology admissions private insurance accounted for 23.9%. Most prevalent diagnosis for PRD admissions corresponded to IgA Vaculitis (33%), juvenile idiopathic arthritis (16%), systemic lupus erythematosus (9%) and Kawasaki disease (8.5%). Yearly admissions due to PRDs did not have significant variations during the study period. 70% of PRD admissions occurred in hospitals with a PR. Poisson Rate Ratio comparing admissions in hospitals with and without PR revealed a significantly higher rate of PRD admissions in hospitals with a PR (PRR 1.27, 95%CI 1.23–1.31). Poisson Rate Ratios for specific PRDs showed higher rates of admission in hospitals with a PR for juvenile idiopathic arthritis (PRR 1.42, 95%CI 1.3–1.55), Kawasaki disease (PRR 2.15, 95%CI 1.87–2.47), systemic lupus erythematosus (PRR 1.63, 95%CI 1.44–1.85), and juvenile dermatomyositis (PRR 2.22, 95%CI 1.76–2.81) but not for IgA vasculitis (PRR 1.04, 95%CI 0.98–1.1).



Conclusion:

In Chile, hospital admissions due to a PRD are more frequent in hospitals with a PR than without. Compared with hospitals with a PR, centers without a PR appear to have similar admission rates for IgA vasculitis, suggesting non-PRs have the ability to diagnose, treat and discharge patients with this condition, but have lower admission rates of other PRDs. These lower rates may be due to referral to tertiary centers with a PR or due to a missed diagnosis. This study reinforces the urgent need for more PRs throughout the country.