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An index for evaluating results in paediatric cardiac intensive care
Sandra S Mattos1, Juliana R Neves, Mônica C Costa
1Unidade de Cardiologia & Medicina Fetal, Real Hospital Português, Recife, Brazil. ssmattos@cardiol.br
Insights
A new clinical and surgical index effectively predicts in-hospital mortality in pediatric cardiac surgery patients. The index, based on age, nutrition, risk factors, complexity, and bypass time, shows strong correlation with adverse outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Clinical Risk Assessment
- Surgical Outcomes
Background:
- In-hospital mortality after pediatric cardiac surgery remains a critical concern.
- Predictive tools are essential for risk stratification and improving patient care.
Purpose of the Study:
- To develop and validate a novel clinical and surgical index for predicting in-hospital mortality in children undergoing cardiac surgery.
- To assess the correlation between the proposed index and actual mortality rates.
Main Methods:
- Retrospective, cross-sectional observational study of 818 pediatric cardiac surgery patients (2000-2004).
- Development of a risk index based on five variables: age, nutritional state, clinical risk factors, surgical complexity, and cardiopulmonary bypass duration.
- Risk scores (0-2) assigned to categories (low, medium, high) for each variable.
Main Results:
- Overall in-hospital mortality was 14.7%.
- The proposed index demonstrated a strong linear correlation with mortality (p < 0.0001).
- Mortality increased significantly with higher index scores, from ~10% to over 50%.
Conclusions:
- Neonatal surgery, low weight (<5th percentile), associated clinical risk factors, complex procedures, and prolonged cardiopulmonary bypass (>90 minutes) are significant predictors of mortality.
- The new index is a valuable tool for predicting adverse outcomes in pediatric cardiac surgery.
Objective:
To determine if in-hospital mortality after cardiac surgery can be predicted, in children, using a new clinical and surgical index.
Study Design:
Observational, retrospective, cross-sectional.
Methods:
We reviewed 818 charts from children undergoing surgery between January, 2000, and December, 2004. The index was calculated by summing the scores from five variables, specifically age, nutritional state, the presence of associated clinical risk factors, surgical complexity, and use and time of cardiopulmonary bypass. Each variable was subdivided into categories of low, medium or high risk, with scores attributed as zero, one or two, respectively. Risks for death were calculated using the odds ratio.
Results:
Our overall mortality was 14.7%, with our proposed index correlating strongly with mortality (p less than 0.0001). No patients died with scores of zero, but mortality increased from around 10% with a score of three, to close to 30% with scores of five and six, and to over 50% with a score of eight. No patients reached scores of 10, and more than three-fifths of all patients had scores between zero and three. We observed higher mortalities independently for each variable in association with the highest risk scores.
Conclusions:
We found that surgery undertaken in the neonatal period, weight below the 5th percentile, the presence of associated clinical risk factors, operations of higher complexity, and more than 90 minutes of cardiopulmonary bypass were all significantly associated with mortality. Our suggested new index showed a linear correlation with mortality, and in our current experience, has proved a valuable tool for predicting adverse outcomes.
