title: Early diagnosis of extrahepatic biliary atresia in an open-access medical system.
abstract: BACKGROUND
  Biliary atresia (BA) is the most common cause of cholestatic jaundice in infancy. Early diagnosis and surgical management, ideally before 60 days of age, result in improved outcomes. We aimed to determine the age at diagnosis of BA in the Military Health System (MHS) and to compare the age at diagnosis by access to care models. We hypothesized that children with BA receiving primary care in military facilities have an earlier age at diagnosis due to decreased economic and access barriers.
  
  
  METHODS
  Data for all Tricare enrollees born in fiscal years 2004-2008 with a diagnosis of BA were extracted from MHS databases. Non-parametric tests, Kaplan-Meier curves and log rank tests compared differences in age at diagnosis by type of primary care facility, gender, prematurity and presence of additional anomalies.
  
  
  RESULTS
  64 subjects were identified within the five year period. Median age at diagnosis was 40 days [range 1-189], with 67% diagnosed by 60 days and 80% by 90 days. 45 (70%) received civilian primary care within the MHS. There was no difference in the median age at diagnosis between subjects in the MHS with civilian primary care vs. military primary care (37 days [1-188] vs. 46 days [1-189]; p=0.58).
  
  
  CONCLUSIONS
  In the MHS, two-thirds of infants with biliary atresia are diagnosed prior to 60 days of life. Gender, prematurity or presence of additional anomalies do not affect the timing of diagnosis. Civilian and military primary care models within the MHS make timely diagnoses of biliary atresia at equivalent rates.
authors.affiliation: Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America. jhollon1@jhmi.edu
authors.forename: Justin
authors.initials: J
authors.lastname: Hollon
authors.forename: Matilda
authors.initials: M
authors.lastname: Eide
authors.forename: Gregory
authors.initials: G
authors.lastname: Gorman
mesh_terms: D000465:Algorithms; D001656:Biliary Atresia / Q000175:diagnosis*; D016208:Databases, Factual; D042241:Early Diagnosis; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health; D008297:Male; D008889:Military Personnel; D015233:Models, Statistical; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D014481:United States