Referral pattern of children with cardiac diseases: a cross-sectional review of referral documents in three teaching hospitals in Addis Ababa

Abstract

Background: Patients with hemodynamically significant structural heart lesions often become inoperable if early referral and intervention is not done. Contrarily, referring patients with hemo-dynamically-insignificant lesions congest the already busy tertiary centers. The study aim was to determine the proportion of hemodynamically significant cases with delayed presentation and their determinant factors.

Methods: A cross-sectional study design was used to collect data from 369 referral slips sampled using a single population proportion formula (95% CI, 5% margin of error, and 50% cases coming with a referral paper). Data was analyzed using SPSS software package version 25. Binary logistic regression analysis was done to determine factors associated with referral either to the Tikur Anbessa hospital versus Saint Paul and Yekatit 12 hospitals. Odds ratio with their corresponding confidence interval was used to assess the significance of association and statistically significant associations were declared at p-value < 0.05.

Result: The overall magnitude of delayed presentation beyond 1 year of age among patients with hemodynamically-significant lesions was 54%. Saint Paul and Yekatit-12 hospitals combined had higher referral from primary institutions (AOR=2.68 95% CI-1.64-4.38, p<0.001). Tikur Anbessa hospital had higher referral of congenital heart disease and retention of feedback referral slips compared to the two hospitals (AOR=1.86, 95% CI-1.02-3.41, p=0.004) and (AOR=2.78, 95% CI-1.65-4.69, p<0.001). If the referring health worker was a specialist, and initial symptom was chronic and poly, the likely-hood of being referred to Tikur Anbessa Specialized hospital was higher (AOR=10.34, 95% CI-2.20-48.69, p=0.003) and 1.97, 95% CI-1.21-3.22, p=0.007) respectively. The time lapse between referral and reaching at the referral destination was longer in cases referred to TASH (AOR=2.91,95% CI-1.74-4.88), p<0.001). Feedback slips were sent back to the referring health facilities in only 3% of cases.

Conclusion: Delayed presentation of patients with hemodynamically significant cardiac lesions was tremendous. and unsent or retained feedback referral slips were significant. Future research should focus on active searching for causes of delayed presentation using a well-designed and validated tool.