6375 Central precocious puberty – optimising timeline from referral to treatment

Objectives We are presenting a retrospective audit reviewing referrals of children with suspected central precocious puberty (CPP) over the past 5 years (June 2017 – June 2022). Our aim is to assess the time taken from referral to start of treatment (if indicated), identify factors contributing to delays and propose improvements. The main goal of therapy for CPP is preservations of height potential and the gold-standard of treatment is gonadotropin-releasing hormone (GnRH) analogue.¹ Initiation of treatment is time critical as delays would allow further bone maturation which is irreversible and leads to reduction in final adult height. Although there are no set standards in literature for referral timelines, we aspire to minimise delays and optimise patient's outcomes. Balancing clinical need and investigation capacity we strive to achieve timeline no longer than 10 weeks. Methods We have divided the timeline from referral to treatment initiation into 3 phases: Phase 1- GP referral to first clinic review Phase 2 – Clinic review to GnRH stimulation test (includes bone age testing) Phase 3 – GnRH stimulation test result to treatment with GnRH analogue (includes MRI pituitary) We measured average time in each phase, identified factors causing delays and proposed changes to get our timelines closer to proposed standard. Results During audited time 21 patients were reviewed with suspected CPP, 13 of which were positive for CPP (61.9% of all referrals) – 12 females and 1 male. (CPP is 5 to 10 times more prevalent in females²). Average times for each phase (according to phases presented above) and identified limiting factors causing delays are summarized in table 1. Data revealed the following timelines: Overall, the time from referral to treatment following usual investigation pathway was 13.8 ± 3.8 weeks. Conclusion Achieved timeline is 3.8 ± 3.8 weeks longer than proposed standard. To achieve standard we propose the following changes: Phase 1: Prompt triage Review in Specialist Endocrinology Clinic rather than in General Paediatric Clinic Improve capacity in the Endocrinology Clinic Phase 2: Increase the capacity of daycase unit Phase 3: Not wait for MRI scan result before treatment is initiated Moving to 3 monthly or 6 monthly Decapeptyl instead of short-acting Gonapeptyl (Day 0, 14, 28 and 56) to fast-track treatment lowering pressure on the nursing team administering treatment References Chen M, Eugster EA. Central precocious puberty: update on diagnosis and treatment. Paediatr Drugs 2015 Aug;17(4):273–81. doi: 10.1007/s40272-015-0130-8. PMID: 25911294; PMCID: PMC5870137. Cesario SK, Hughes LA. Precocious puberty: a comprehensive review of literature. J Obstet Gynecol Neonatal Nurs 2007 May-Jun;36(3):263–74.