G124 TRIAGING OF REFERRAL LETTERS TO A FAST TRACK INFLAMMATORY ARTHRITIS CLINIC

H. Ali, M. Friswell, T. Bell, H. E. Foster. Departments of Rheumatology and Child Health, University of Newcastle, Newcastle upon Tyne Hospitals NHS Trust

Introduction: There is an increasing trend to earlier and aggressive treatment in juvenile idiopathic arthritis (JIA), with emerging evidence that earlier intervention is associated with better outcome. Owing to long waiting times for routine new patient clinics, a fast track clinic was established in September 2002 to prioritise children with inflammatory arthritis and facilitate early assessment and management by the multidisciplinary team (MDT).

Aim: To assess the accuracy of triaging referral letters by clinician to either fast track or routine clinic appointment of new patients.

Method: 91 consecutive new referral letters were analysed along with new patient clinic letters. Two consultants (MF and HF) independently categorised referral letters as JIA/inflammatory or non-inflammatory. All children have been reviewed by both consultants in the clinics. Triage diagnosis v final clinic diagnosis was compared to measure sensitivities, specificities, and predictive values.

Results: 54 females and 37 males with a median age of 10.7 years. 54 (59.3%) of referrals were made by GPs, the remaining either by paediatricians or orthopaedics surgeons. 18 cases had inflammatory arthritis (16/18 (88.9%) JIA, SLE n = 1, Down’s associated arthritis n = 1). The remaining 73/91 had non-inflammatory conditions. Between the consultants, for triage and final diagnosis, the sensitivity for detecting inflammatory arthritis was 100% each with specificities of 68.49% and 60.27%, positive predictive values of 44% and 38%. Current waiting time is 4 weeks for fast track and 9 weeks for routine new patient appointments.

Conclusion: Both consultants were able to reliably triage referral letters, as no case with inflammatory arthritis was missed. However, improving triage specificity is required for optimum utilisation of the fast track clinics.

G125 WHAT’S IN A NAME? DISEASE KNOWLEDGE IN JUVENILE IDIOPATHIC ARTHRITIS (JIA)

K. L. Shaw, T. R. Southwood, J. E. McDonagh, the …