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

Background The actual yield from current screening for clinically significa nt congenital heart malformations in Dutch child health care is far from op timal. In this study factors that determine the effectiveness of this scree ning are identified and recommendations for the optimization of the screeni ng programme are formulated. Methods Eighty-two patients with a clinically significant congenital heart malformation were consecutively included in this study. Parents and child h ealth centre physicians were interviewed in order to establish the screenin g, detection and referral history. Paediatric cardiologists established whe ther these patients were diagnosed 'in time' or 'too late'. Results Incomplete performance of the screening examination has more influe nce on the occurrence of delayed diagnoses than failure by parents to adher e 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 w as 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.