AB1092 An audit on paediatric uveitis in the greater glasgow and clyde (GGC) service: guideline adherence and impact on patient outcomes
Authors: E. Parmar, J. Waddell, J. Gardner-Medwin
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> 2010 guidelines from the Scottish Paediatric and Adolescent Rheumatology Network (SPARN) and the Scottish Uveitis Network (SUN) outlined management pathways for paediatric uveitis. Given the time since its establishment and last review, an audit on the GGC service's adherence to the guidelines as well as patient outcomes was conducted. <h3>Objectives</h3> To determine the service's compliance to the SPARN/SUN guidelines for the management of paediatric uveitis, in addition to establishing patient outcomes and identifying current shortcomings and areas for improvement in future practice. We also aimed to provide data to inform the revision and updating of the guideline for the year 2018. <h3>Methods</h3> This retrospective audit was conducted by collecting data from patients within the GGC's Royal Hospital for Children's joint rheumatology and ophthalmology service who were diagnosed with uveitis between the 1st of <sup>January 2008</sup> and the 31st of December 2017. The data was then compared to the guidelines set by SPARN/SUN, in addition to a study conducted by this service prior to the guideline's development. <h3>Results</h3> 39 suitable patients were identified from the list of 253. From these patients, 92 separate events of uveitis were recorded – 84 of which ended in remission within the audit period. 17 events (20%) remained active after 7 months and required ongoing treatment, falling out with the guideline's standards. Time to remission was further stratified by modality of treatment. Of the 78 eyes evaluated, 7 eyes in 5 patients were found to have had cataracts. This comprises 12.8% of patients, an improvement from the 29% of the previous study. Notably, 5 of the 7 eyes had cataracts detected at the first appointment with the service. An additional 7 eyes across 6 patients (15%) were recorded to have had cystoid macular oedema, which is comparable to the previous study's 11%. A majority of these (4 of 7 eyes, or 57%) were again discovered to already be present at the first appointment. <h3>Conclusions</h3> Guideline adherence was commendable, though improvement is needed in treatment escalation to decrease the time taken for patients to achieve remission. There exists a tendency to maintain patients on topical steroid therapy due to relapsing and remitting disease activity, though given the high risk of glaucoma, consideration should be given to quickly progressing these patients up the treatment ladder. A large proportion of patients with severe complications of uveitis appear to have developed these prior to their first attendance at the service, suggesting a need for more stringent screening processes for early detection. Overall, outcomes in terms of the number of patients affected by complications of uveitis appear to have improved when compared to the study previously conducted by the service, implying a beneficial effect from adherence to the implemented guidelines. <h3>References</h3> [1] Scottish Uveitis Network (2010). <i>Uveitis NMCN Treatment Guidelines</i>. Available from: http://www.sun.scot.nhs.uk/Documents/uveitis%20treatment%20guideline%20sep%2020101revised%20.pdf [2] Jalila M, Galea P, Gardner-Medwin J, Lavy T. (2004) <i>Chronic Uveitis in Children with JIA.</i> Acquired from: Dr Janet Gardner-Medwin, Paediatric Rheumatology, Royal Hospital for Children, Glasgow. <h3>Acknowledgements</h3> We would like to thank the staff at the Royal Hospital for Children, Glasgow for their cooperation during this audit. <h3>Disclosure of Interest</h3> None declared