CLSIG diagnostic pathway It is important that children and young people with lymphoedema are assessed and investigated thoroughly by appropriately qualified/experienced clinicians. There are two highly specialised lymphoedema units in the UK (Derby and London) but because of time, distance, and cost issues it is not always possible for some children to be assessed there. In collaboration with St George’s, CLSIG has developed this diagnostic pathway to allow clinicians to perform as much of the assessment and investigation as possibly locally, while providing the opportunity to consult with the specialist centres throughout this process until a definitive diagnosis is achieved. There is also the opportunity for clinicians to refer direct to the specialist centres if local services do not have access to the required assessment investigative tools. This pathway should be used in conjunction with the St George’s Paediatric investigation pathway and the classification system algorithm. Details of your local genetics team can be found at -http://www.geneticalliance.org.uk/services.htm CLSIG July 2015 (review July 2016)

CHILDHOOD LYMPHOEDEMA ASSESSMENT/DIAGNOSTIC PATHWAY ASSESMENT/DIAGNOSTIC PATHWAY REFERRAL RECEIVED BY LYMPHOEDEMA SERVICE Refer to local genetics dept ABLE TO ASSESS/DIAGNOSE using St George’s pathway? NO YES FOLLOW ST GEORGE’S PATHWAY DIAGNOSIS REACHED MORE INVESTIGATIONS required REFER TO/CONSULT WITH DERBY Or ST GEORGE’S (GP or consultant can refer) REFER/CONSULT WITH LOCAL GENETICS/PAEDIATRIC CENTRE DIAGNOSIS REACHED NO YES MANAGE LYMPHOEDEMA AT LOCAL SERVICE CLSIG July 2015 (review July 2016)

Connell (2013) Clin. Genet