269 - Characteristics of Complex Patients in a Multidisciplinary Diagnostic Consultation Program

Poster Number: 269
Publication Number: 269.207

Background: The Pediatric Diagnostic Program (PDP) at Boston Children’s Hospital is a multidisciplinary outpatient consultative service for patients seeking second opinions about multisystem symptoms. These families often seek out multiple medical opinions without achieving consensus or coordination between specialists. Patients with somatoform disorders are even more likely to have frequent medical evaluations, which can delay access to coordinated treatment plans. PDP intends to support families in clarifying diagnoses and treatment plans to prevent costly and frustrating medical odysseys. Patients are referred by PCPs, specialists, or caregivers to PDP’s multidisciplinary team of pediatricians, behavioral health specialists, and nurses. PDP then conducts a structured intake with caregivers, evaluates the patient, and coordinates appointments with relevant specialists.

Objective: The study aims to describe patients served by PDP, including demographics, presenting symptoms, and diagnoses rendered during evaluation. This descriptive information is a preliminary step in assessing the use of PDP and referral patterns.

Design/Methods: A research assistant chart reviewed 76 patients seen 5/2017–11/2020. Demographics, presenting symptoms, medical history, and diagnoses rendered by PDP were collected from the intake forms, generalist and behavioral health evaluations, and records from previous institutions.

Results: Median patient age was 14 years and average age was 12.2. Patients were predominantly white (76.3%), English-speaking (98.7%), residents of the northeast (68.4%), and had private health insurance (84.2%) (Table 1). Common presenting concerns included fatigue (68.4%), headache (63.2%), and abdominal pain (50.0%) (Table 2). Prior to PDP, 68.4% sought care at 3 or more institutions and 59.3% saw more than 7 specialists. Common diagnoses given by PDP included somatoform disorder (47.4%), anxiety (46.1%), and pain amplification (25%) (Table 3). Most patients received multiple diagnoses (72%), and 81.6% received at least one new diagnosis.

Conclusion(s): Patient presentations were varied and reflected multisystem symptom profiles. The high rate of new diagnoses indicates the program provides families with additional diagnostic information. Frequent diagnosis of somatoform disorders suggests a need for exploration of ways to shorten diagnostic odysseys. The homogeneity of our patient demographics points to disparities in access to PDP that warrant further investigation. Limitations include inability to assess interrater reliability due to staffing and use of DSM-IV diagnostic criteria for somatoform disorders.