Retrospective data analysis of referral letters for orofacial vascular anomalies to a tertiary center.

Abstract

Background: Vascular anomalies are disorders of the vascular system. These anomalies are classified as either vascular tumors or vascular malformations, with each possessing distinct characteristics. This study was performed to analyze vascular anomaly referrals to a tertiary center, identify patterns of misdiagnosis, and create a proforma to ensure the comprehensiveness of clinical information.

Methods: We retrospectively analyzed vascular anomaly referral letters received by Hospital Tunku Azizah from 2018 to 2023. Specifically, we descriptively analyzed the inclusion of vascular anomaly characteristics, the demographic profiles of referrers and patients, and basic clinical findings. Subsequently, we developed a redesigned proforma.

Results: Overall, 47 referral letters were analyzed. The patients comprised 25 boys and 22 girls, with ages ranging from birth to 14 years. Patient name, sex, and date of birth, along with the referrer's name and address, were satisfactorily documented. The review revealed that 44 (93.6%) of the letters included the patient's presenting problem, 43 (91.5%) contained clinical findings, 37 (78.7%) reported diagnostic investigations, and 29 (61%) referenced medical history. Regarding characteristics of vascular conditions, over half of the letters detailed time of appearance (n= 40, 85%), growth (n= 24, 66%), complications (n= 25, 53.2%), color (n= 32, 68%), and shape (n= 34, 72%). However, fewer than half mentioned compressibility (n= 7, 14.8%), pulsation (n= 7, 14.7%), and associated conditions (n= 2, 4.3%), and none referenced involution.

Conclusion: Although demographic data were generally well-documented, critical medical history information was frequently omitted, including a lack of adequate pre-referral investigations. Key characteristics of vascular anomalies, namely compressibility, pulsation, associated conditions, and involution, were frequently overlooked. Accurate documentation of these features is crucial for determining treatment urgency. A standardized proforma must be implemented to ensure that vital information is captured, thus facilitating diagnosis and optimizing patient care.