E007 Validation of Step 1 of the DETECT score to screen for pulmonary arterial hypertension in scleroderma spectrum disorder patients and its impact on routine echocardiogram utilization

Pulmonary arterial hypertension (PAH) is a severe complication in patients with Scleroderma Spectrum Disorders (SSDs), and early detection improves outcomes. While echocardiography is commonly used to screen for PAH in SSD patients, it is often inaccurate when used alone. The DETECT algorithm (2015) is a more precise screening tool designed to identify SSD patients at high risk for PAH. Step 1 of the DETECT score involves non-invasive assessments (clinical symptoms, pulmonary function tests, and laboratory results) to determine if further evaluation with echocardiography (Step 2) is necessary. Routine echocardiography for all SSD patients can lead to unnecessary procedures, longer waiting times, and increased healthcare costs. This audit aims to assess the use of Step 1 of the DETECT score in identifying patients who truly need echocardiograms, potentially improving early PAH detection while reducing unnecessary echocardiograms.

This retrospective audit included SSD patients treated at the Rheumatology Department of Queen Alexandra Hospital, Portsmouth, between January 2022 and November 2023. Data from 156 SSD patients were collected and reviewed, including those diagnosed with limited scleroderma, diffuse scleroderma, mixed connective tissue disease with scleroderma features, scleroderma overlap syndrome, Anti Th To, undifferentiated connective tissue disease (CTD), and morphoea. Pulmonary function test results, specifically the TLco parameter, were examined for all patients over the last 12 months.

Of the 156 SSD patients, 76 (48.7%) had Limited Scleroderma, 46 (29.4%) had Diffuse Scleroderma, 10 (6.4%) had mixed connective tissue disease, 18 (11.5%) had scleroderma overlap, 2 (1.3%) had Anti Th To, 3 (1.3%) had undifferentiated CTD, and 1 (0.64%) had morphoea. The female-to-male ratio was 9.4:1. Forty-seven patients (30.1%) lacked recent pulmonary function tests required for the DETECT score. Of these, 23 (14.7%) had been diagnosed with SSD for more than three years, making them potentially eligible for DETECT. Sixteen patients (10.3%) had a TLco <60%; of these, 10 had SSD for more than three years and 6 for less than three years. Therefore, only 10 patients out of 156 qualified for PAH screening using the DETECT score.

The findings support using Step 1 of the DETECT score as a preliminary screening tool before considering echocardiography in SSD patients. This approach can identify eligible patients for further PAH evaluation and reduce unnecessary echocardiograms, resulting in significant cost savings without compromising care.

T. Nasrin: None. L. Parker: None. A. Scott-Russell: None. D. Knight: None. M. Chakraborty: None.