Related Experiment Video
Updated: May 12, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Real time monitoring of risk-adjusted paediatric cardiac surgery outcomes using variable life-adjusted display:
Christina Pagel1, Martin Utley, Sonya Crowe
1Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK. c.pagel@ucl.ac.uk
Objective:
To implement routine in-house monitoring of risk-adjusted 30-day mortality following paediatric cardiac surgery.
Design:
Collaborative monitoring software development and implementation in three specialist centres.
Patients And Methods:
Analyses incorporated 2 years of data routinely audited by the National Institute of Cardiac Outcomes Research (NICOR). Exclusion criteria were patients over 16 or undergoing non-cardiac or only catheter procedures. We applied the partial risk adjustment in surgery (PRAiS) risk model for death within 30 days following surgery and generated variable life-adjusted display (VLAD) charts for each centre. These were shared with each clinical team and feedback was sought.
Results:
Participating centres were Great Ormond Street Hospital, Evelina Children's Hospital and The Royal Hospital for Sick Children in Glasgow. Data captured all procedures performed between 1 January 2010 and 31 December 2011. This incorporated 2490 30-day episodes of care, 66 of which were associated with a death within 30 days.The VLAD charts generated for each centre displayed trends in outcomes benchmarked to recent national outcomes. All centres ended the 2-year period within four deaths from what would be expected. The VLAD charts were shared in multidisciplinary meetings and clinical teams reported that they were a useful addition to existing quality assurance initiatives. Each centre is continuing to use the prototype software to monitor their in-house surgical outcomes.
Conclusions:
Timely and routine monitoring of risk-adjusted mortality following paediatric cardiac surgery is feasible. Close liaison with hospital data managers as well as clinicians was crucial to the success of the project.
