Resource Overutilization in the Diagnosis of Lymphedema Praecox

Adil A. Shah a,b,⁎, Mikael Petrosyan a, Wasay Nizam b, Jeffrey Roberson a,c, Philip Guzzetta a. Journal of Pediatric Surgery 2019

Abstract

Resource Overutilization in the Diagnosis of Lymphedema Praecox

Adil A. Shah a,b,⁎, Mikael Petrosyan a, Wasay Nizam b, Jeffrey Roberson a,c, Philip Guzzetta a. Journal of Pediatric Surgery 2019

Purpose: Primary lymphedema presenting in adolescence is known as lymphedema praecox. Older children presenting with leg swelling are often subjected to a myriad of diagnostic tests. The purpose of this study is to review a large-cohort of patients with lymphedema praecox to determine the fiscal impact of diagnostic testing on these patients.

Methods: A 13-year review was performed of patients with lymphedema praecox. Information was obtained on demographic parameters, diagnostic studies performed, and clinical outcomes.

Results: Forty-nine patients were identified. The median age was 14 (range: 7–21) years. Participants were predominantly female (n = 40, 81.6%). 19 patients had bilateral disease and 30 had unilateral disease. The diagnosis was made on clinical exam only in 14 patients. 35 patients had imaging which consisted of plain X rays, Doppler ultrasound (DUS), lymphoscintigraphy (LSG) or MRI as the sole imaging study (n = 28) or in combination with others (n = 7). The charges for plain X-rays, DUS, LSG, and MRI with contrast were $335, $1715, $1269, and $6006 respectively.

Conclusion: We believe that in the adolescent female with physical findings consistent with lymphedema praecox, diagnostic imaging should be limited to a Doppler ultrasound to rule out a secondary cause of the swelling.

Main findings

  • Estimates have suggested that roughly 30% of healthcare expenditure is unnecessary.
  • The purpose of this study is to review a group of lymphedema praecox patients to determine what are appropriate diagnostic studies, as well as the fiscal impact of testing patients.
  • Lymphedema praecox represents the most common form of primary lymphedema. It is believed to be the delayed presentation of an underlying genetic defect.
  • it is prudent that some imaging be done to rule out other potential causes of leg swelling such as deep venous thrombosis, a vascular anomaly or a mass obstructing the lymphatics.
  • Painless lower extremity swelling in the older child can be accurately diagnosed to be because of lymphedema praecox by careful history, physical exam and DUS of the effected extremity (ies) and unwarranted, time consuming, and invasive testing may be the source of significant cost, stress and anxiety for patients and parents. Based on the authors experience with 49 patients with lymphedema praecox, they believe that this approach is accurate and cost effective.