TO THE PROBLEM OF ROUTING CHILDREN WITH LYMPH NODE ENLARGEMENT SYNDROME
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Abstract
Lymphadenopathy (LAP) in children is a frequent cause of referrals to the doctor. In industrial regions of Russia, the problem of late diagnosis of malignant LAP is urgent, which makes it necessary to analyze patient routing.
Aim of the study – to analyze the routing of children and adolescents with lymph node enlargement syndrome to identify the causes of late diagnosis of malignant LAP.
Materials and Methods. From January 2019 to December 2023, a study of 4140 children with LAP syndrome was conducted, of which 474 patients (11,4%) were included in the analysis according to inclusion and exclusion criteria.
Study results. At the time of first referral, 37,1% of children were diagnosed with unspecified lymphadenitis, 17,3% with tuberculosis, 16,9% with reactive hyperplasia, 12,4% with herpetic infection, and 8,2% with malignant LAP. The median time to diagnosis for malignant LAP was 46,5 days (p < 0,001).
Correlation analysis revealed the association of diagnosis time with residence in Novokuznetsk (r = 0,746), hepatosplenomegaly (r = 0,753), combination of lymph node characteristics (r = 0,670), malignant LAP (r = 0,669), B-symptoms (r = 0,581), and number of specialists involved (r = 0,377). Single-factor analysis identified factors that significantly increased the risk of prolonged diagnosis: each day before the first visit to a physician (odds ratio (OR) = 1,092 [1,040-1,146]), duration of diagnosis (OR = 1,285 [1,174-1,407]), number of outpatient specialists (OR = 5,090 [2,729-9,493]), primary hospitalization (OR = 7,083 [2,096-23,936]), and number of complaints (OR = 1,407 [1.056-1,875]).
Multivariate analysis confirmed the independent effect of three parameters: time to first referral, duration of diagnosis, and number of consulting specialists.
Conclusion. The results indicate the need to improve routing and organizational processes to reduce the time to diagnosis in children with suspected malignant pathology.
Keywords
Author Biographies
Марина Михайловна Котович,
Kotovich Marina MikhailovnaMD, PhD, professor.
She is a Professor at the Department of Pediatrics, Neonatology and Сlinical Pharmacology of the Novokuznetsk State Institute of Advanced Medical. She is a member of Russian Organization of Liver Diseases and Russian Gastroenterology Organization.
She graduated from the Pediatric Faculty of Kemerovo Medical institute in 1983. She defended her dissertation for the degree of Candidate of Medical Sciences on the theme “Autoimmune Hepatitis in Children (clinical picture, morphology, treatment)” in 1995 and her doctoral thesis on the theme “The Role of Etiotropic and Pathogenetic Therapy in Clinical and Morphological Evolution of Chronic Hepatitis in Children”.
She is an author of more than 120 scientific works and 2 scientific methodological manuals. She always upgrades her professional level, makes scientific reports within important Russian and International forums. In 2000 her report for “Hepatology Today” Congress was awarded a the 1st degree diploma.
She is a highly qualified pediatrician, multifunctional worker, whose priorities are hematology, immunology, perinatal pathology, congenital and hereditary diseases. She has developed and implemented into the practice methods of early diagnostics of mentioned disorders, more effective methods of treatment (including fatality and disability prevention). She regularly upgrades her professional and pedagogical skills, She also provides broad advice to practical health care.Григорий Михайлович Сергиенко,
pediatric oncologist; assistant of the department of pediatrics and neonatologyЯков Яковлевич Яковлев,
candidate of medical sciences, docent, head of the department of pediatrics and neonatologyArticle Details
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The authors declare that they have no apparent or potential conflicts of interest related to the publication of this article.
This work is licensed under a Creative Commons Attribution 4.0 License.
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