Consult and Referral Guidelines

Tips for an effective visit:

Talk with your patient and family about the reason for the referral and the questions to be answered.
Please send all pertinent information ahead of time to allow us to better serve our patients and their families.

For more information call (803) 434-7950.

Asthma, Recurrent Cough and Wheeze

Evaluation Prior to Referral

Chest x-ray

When to Refer

Following hospitalization, especially in ICU
Frequent ER visits
Complicating conditions such as failure to thrive, prematurity, BPD, pneumonia
Frequent need for oral steroids
Unresponsive to conventional therapy
Requiring treatment consistent with Step 3 of NHLBI Guidelines

What to Send

Chief concern
List of treatments and response
Respiratory history since birth
Chest x-rays

Comments

Work up may include:

Spirometry in children aged 5 years or older
Chest x-ray
Laboratory work-up (serum IgE, RAST testing, etc.)

Bronchopulmonary Dysplasia, Chronic Lung Disease

Evaluation Prior to Referral

Chest x-ray
Oxygen saturation

When to Refer

Supplemental oxygen requirement
Unstable respiratory status
Poor growth or g-tube feedings
Re-hospitalization after discharge from NICU
Unable to wean oxygen or other medications (e.g., diuretics)
Complicating conditions (e.g., tracheostomy or pulmonary hypertension)
Needs RSV prophylaxis

What to Send

Chief concern
NICU discharge summary
Current oxygen requirement
List of medications
Growth chart
Chest x-rays

Comments

Work up may include:

Chest x-ray
Serum electrolytes
Blood gas

Sleep Apnea / Sleep Breathing Disorder

Evaluation Prior to Referral

Sleep study
Trial of nasal steroids

When to Refer

Symptoms of sleep disordered breathing:

Snoring with observed apnea
Daytime somnolence
Growth delay

Abnormal result on sleep study

What to Send

Chief concern
Results of sleep studies, if done
Prior ENT evaluations, if done
List of treatments and response

Comments

Work up may include:

Pulmonary function testing
Sleep study
Echocardiogram
Blood gas analysis
Referral to ENT

Cystic Fibrosis

Evaluation Prior to Referral

Chest x-ray
Sweat chloride (at CF Center accredited laboratory)

When to Refer

Positive newborn screening
Positive sweat testing
Symptoms of cough, wheeze, malabsorption, or failure to thrive with a family history of CF

What to Send

Sweat chloride results
Genotyping results, if done
Chest x-rays
Growth curve

Comments

Workup may include:

Pulmonary function testing in children aged 5 years or older
Repeat sweat testing
DNA analysis
Laboratory tests, including vitamin levels, LFTs, electrolytes
Sputum culture or throat culture
Chest x-ray

Chronic Cough, Recurrent Pneumonia, Noisy Breathing, Chest Pain, Tachypnea

Evaluation Prior to Referral

Chest x-rays
Sweat test if ruling out cystic fibrosis
Laboratory studies, e.g. CBC, electrolytes, etc.

When to Refer

Abnormal growth or development
Recurrent illness despite treatment
Increasing respiratory symptoms
Interference with daily activities or excessive school absenteeism

What to Send

Chest x-rays
Respiratory history
List of treatments and response
Laboratory results

Comments

Work up may include:

Pulmonary function testing in children aged 5 years or older
Chest x-ray
Sweat testing
Laboratory testing (for evidence of infection, allergy, immune deficiency, collagen vascular disease, etc.)
Bronchoscopy