Incidência e avaliação do fluxo de recém-nascidos com o teste do reflexo vermelho alterado nos Departamentos Regionais de Saúde II, VI, IX e XI do estado de São Paulo
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2017-08-18
Autores
Madi, Ana Carolina Goyos [UNESP]
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Universidade Estadual Paulista (Unesp)
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Objetivo: Avaliar o fluxo assistencial e a incidência do Teste do Reflexo Vermelho (TRV) alterado em nascidos vivos das DRS II, VI, IX e XI do estado de São Paulo, por meio de informações fornecidas pela Linha de Cuidados do Exame do Olhinho. Métodos: Realizado um estudo observacional, longitudinal e retrospectivo, por meio da análise de dados do sistema de informações da Central de Regulação e Ofertas de Serviços de Saúde (CROSS). Foram analisados dados referentes ao resultado do Teste do Reflexo Vermelho (normal, duvidoso ou alterado) no período de outubro de 2015 a setembro de 2016, das Maternidades, dos Hospitais que realizam parto, dos Centros de Reteste (destino 1) e dos Centros de Referência (destino 2), da região que tem como destino 2 o Hospital das Clínicas da Faculdade de Medicina de Botucatu (HCFMB) – UNESP (DRS II, VI, IX e XI do estado de São Paulo). Resultados: Observou-se que 257 RN tiveram o TRV classificado por médicos não oftalmologistas como alterado/duvidoso nas maternidades e em hospitais que realizam parto, sendo 63 no DRS II, 115 no DRS VI, 33 no DRS IX e 46 no DRS XI. Considerando o número total de 55.291 NV, em média 0,465% dos testes realizados nas maternidades/ hospitais da região foram classificados como alterados ou duvidosos, necessitando de exame com o oftalmologista (aproximadamente 1:200 NV). Dos 236 RN que passaram pelo reteste, sete (2,96%) tiveram o teste confirmadamente alterado. Sendo assim 97,04% dos testes das maternidades/ hospitais foram falso positivos. Dos sete RN com TRV alterado, quatro (57,2%) não chegaram ao destino 2, um faleceu, dois não foram agendados e outro não compareceu. Não consta reconvocação ou busca ativa destas crianças no sistema. Os três RN atendidos pelo HCFMB (destino 2) tiveram os seguintes diagnósticos: catarata polar anterior no olho direito, membrana inflamatória retiniana em olho esquerdo e coriorretinite por toxoplasmose bilateral. Conclusão: A incidência do Teste do Reflexo Vermelho confirmadamente alterado foi de 1,27: 10.000 nascidos vivos e o nosso estudo evidenciou falhas no fluxo assistencial quanto ao agendamento, busca ativa e/ ou registro de pacientes faltosos.
Objective: To review the flow of healthcare assistance and the incidence of abnormal results of Red Reflex Tests (RRT) in live births reported by the Regional Healthcare Departments DRS II, VI, IX and XI in the state of São Paulo, using information provided by the Eye Examination Healthcare Line. Methods: An observational, longitudinal and retrospective study was conducted using data from the Central de Regulação e Ofertas dos Serviços de Saúde -- CROSS [Centre for Control and Provision of Healthcare Services]. The study covered results of Red Reflex Tests (normal, inconclusive, abnormal) throughout the period October 2015 to September 2016 conducted at Maternity Units, Delivery Hospitals, Retest Centres (Destination 1) and Specialized Centres (Destination 2) in the region which had, as Destination 2, the Hospital das Clínicas da Faculdade de Medicina de Botucatu*HCFMB) [Botucatu Medical School General Hospital] UNESP (DRS II, VI, IX and XI of the state of São Paulo). Results: It was observed that the RRT for 257 neonates was classified by nonophthalmologists as altered / inconclusive in Maternity hospitals and Delivery hospitals, 63 in DRS II; 115 in DRS VI; 33 in DRS IX; and 46 in DRS XI. Considering a total of 55,291 neonates, on average 0.465% of tests conducted at Maternity hospitals / hospitals in the general region were classified as abnormal or inconclusive and required examination by an ophthalmologist (approximately 1:200 neonates). Of the 236 neonates who underwent retesting, seven (2.96%) had the abnormal diagnosis reconfirmed. Thus, 97.04% of tests conducted at Maternity / Delivery hospitals were false positive. Of the seven neonates with abnormal RRT, four (57.2%) did not make it to Destination 2; one died; two were not scheduled; and another did not turn up on the scheduled date. No recall or active search for these infants was recorded in the system. The three children treated at the HCFMB (Destination 2) were diagnosed to have: anterior polar cataract in the right eye; retinal inflammatory membrane in the left eye; and bilateral toxoplasmosis chorioretinitis. Conclusion: The incidence of confirmed diagnoses of abnormal Red Reflex Tests was 1.27: 10,000 live births, and our study showed evidence of flaws in the flow of healthcare assistance, mainly in relation to scheduling active search and/or recording patients who failed to attend.
Objective: To review the flow of healthcare assistance and the incidence of abnormal results of Red Reflex Tests (RRT) in live births reported by the Regional Healthcare Departments DRS II, VI, IX and XI in the state of São Paulo, using information provided by the Eye Examination Healthcare Line. Methods: An observational, longitudinal and retrospective study was conducted using data from the Central de Regulação e Ofertas dos Serviços de Saúde -- CROSS [Centre for Control and Provision of Healthcare Services]. The study covered results of Red Reflex Tests (normal, inconclusive, abnormal) throughout the period October 2015 to September 2016 conducted at Maternity Units, Delivery Hospitals, Retest Centres (Destination 1) and Specialized Centres (Destination 2) in the region which had, as Destination 2, the Hospital das Clínicas da Faculdade de Medicina de Botucatu*HCFMB) [Botucatu Medical School General Hospital] UNESP (DRS II, VI, IX and XI of the state of São Paulo). Results: It was observed that the RRT for 257 neonates was classified by nonophthalmologists as altered / inconclusive in Maternity hospitals and Delivery hospitals, 63 in DRS II; 115 in DRS VI; 33 in DRS IX; and 46 in DRS XI. Considering a total of 55,291 neonates, on average 0.465% of tests conducted at Maternity hospitals / hospitals in the general region were classified as abnormal or inconclusive and required examination by an ophthalmologist (approximately 1:200 neonates). Of the 236 neonates who underwent retesting, seven (2.96%) had the abnormal diagnosis reconfirmed. Thus, 97.04% of tests conducted at Maternity / Delivery hospitals were false positive. Of the seven neonates with abnormal RRT, four (57.2%) did not make it to Destination 2; one died; two were not scheduled; and another did not turn up on the scheduled date. No recall or active search for these infants was recorded in the system. The three children treated at the HCFMB (Destination 2) were diagnosed to have: anterior polar cataract in the right eye; retinal inflammatory membrane in the left eye; and bilateral toxoplasmosis chorioretinitis. Conclusion: The incidence of confirmed diagnoses of abnormal Red Reflex Tests was 1.27: 10,000 live births, and our study showed evidence of flaws in the flow of healthcare assistance, mainly in relation to scheduling active search and/or recording patients who failed to attend.
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Palavras-chave
Teste do reflexo vermelho, Teste do olhinho, Cegueira infantil, Red reflex test, Eye test, Childhood blindness