Endocrine Abstracts

Introduction

The endocrine assessment of children with Duchenne muscular dystrophy (DMD) can be necessary for management of osteoporosis, delayed puberty, obesity, adrenal insufficiency, and short stature. With ongoing implementation of the international standards of care for DMD, referrals to our Metabolic Bone Clinic (MBC) increased beyond its capacity, impacting patient care. The neuromuscular and endocrine departments implemented a new referral pathway and Multidisciplinary Clinic (MDT) to address patients’ needs more effectively. The MDT runs every other month for one hour. We aimed to evaluate this new clinic by: (1) whether patients were assessed according to the new referral pathway; (2) the time from referral to clinic assessment; and (3) the effect on the Metabolic Bone Clinic capacity.

Methods

We identified children with DMD that attended the MDT and the MBC from September 2021 to March 2022. Data collected included: referral date, referral criteria, auxology, treatment and follow-up plan. Data were extracted prospectively from the electronic patient record.

Results

In total, 61 patients were seen in seven MDTs over one year: median 9 patients/clinic. New referrals totaled 51/61 (84%). The reason for referral aligned with the new pathway in N=44/51 (86%); most frequently for bone mineral density deterioration N=25/61 (49%) and asymptomatic vertebral fracture N=15/61 (29%). ‘Other’ was the only reason for referral for 12/61 (24%).

MDT review was scheduled within a median of 4 weeks (range 0-15) from referral; and N=42/54 (78%) were seen at the next scheduled clinic. New treatment was started in N=16/61 (26.22%) patients, most frequently Bisphosphonates (14/45; 23%). Of new referrals, N=9/54 (17%) were referred to MBC; the remainder were discharged to the Neuromuscular Clinic N=23/54 ( 43%) or followed up in the MDT N=20/54 (37%).

In total, 21 patients were seen in 12 MBCs over the same period, including two new referrals. Follow-up was requested for N=7/21 (33%) and the remainder were discharged (to MDT, Neuromuscular Clinic, or adult services).

Conclusion

A new Multidisciplinary Clinic between Neuromuscular and Endocrine teams successfully followed a new referral pathway for the endocrine assessment of children with DMD; assessed patients within an acceptable timeframe; and increased Metabolic Bone Clinic capacity. The Metabolic Bone clinic were able to discharge one third of their patients to the MDT thereby increasing the clinic capacity. Capacity in the Metabolic Bone clinic was increase by 49 clinic slots since initiating the MDT.