Сердечная недостаточность у детей может проявляться неспецифическими симптомами.

Первичная диагностика сердечной недостаточности у детей является сложной задачей. Такие симптомы как респираторный дистресс, боль в животе, тошнота, рвота, плохой аппетит могут иметь сердечную этиологию.

В ретроспективном обзоре, опубликованном в журнале Pediatrics, было проанализировано истории болезни более 190 детей с впервые выявленной сердечной недостаточностью. Оказалось.что первоначально почти половине пациентов был выставлен ошибочный диагноз. Чаще всего вместо сердечной недостаточности были диагностированы  пневмония, астма, синусит или отит среднего уха, вирусная инфекция и гастроэнтерит. Иследователи призывают педиатров всегда помнить, что острая сердечная недостаточность у детей часто может проявляться неспецифическими симптомами.

Источник: J Pediatr. 2019; 208:258-264.e3. doi: 10.1016/j

 

Missed Diagnosis of New-Onset Systolic Heart Failure at First Presentation in Children with No Known Heart Disease.

Puri K et al

OBJECTIVE:

To determine frequency of missed heart failure diagnosis at first presentation among children with no known heart disease admitted with new-onset heart failure.

STUDY DESIGN:

Using a retrospective design, we reviewed electronic medical records of all patients aged <21 years with no known heart disease, hospitalized with new-onset heart failure during 2003-2015 at a tertiary-quaternary care institution. We assessed records for missed diagnosis of heart failure (primary outcome), associated process breakdowns, and clinical outcomes using a structured data collection instrument.

RESULTS:

Of 191 patients meeting inclusion criteria, 49% (94/191) were missed on first presentation. Most common incorrect diagnostic labels given to "missed" patients were bacterial infection (29%; 27/94), followed by viral illness (22%; 21/94) and gastroenteritis/hepatitis (21%; 20/94). On multivariable analysis, presentation to primary care provider (PCP), longer duration of symptoms (median 7 days), more than 2 symptoms of heart failure, and nausea/emesis were associated with missed diagnosis. On examining process breakdowns, 49% had errors in history-taking and 50% had no documentation of differential diagnoses. There was no difference in hospital mortality, length of stay, or mechanical circulatory support in missed vs not-missed cohorts. Unnecessary noninvasive and invasive tests were performed in 18% and 4% of patients, respectively.

CONCLUSIONS:

Nearly one-half of children with no known heart disease hospitalized with systolic heart failure were missed at first presentation and underwent significant nonrelevant treatment and testing. Initial presentation to the PCP, longer duration of symptoms before presentation, and nausea/emesis were associated with missed diagnosis.

PubMed

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