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The Ratio Fallacy, with Special Reference to the Cardiac Index
1Department of Pediatrics, University of California, 925 Tiburon Boulevard, Tiburon, San Francisco, CA, 94920, USA. jiehoffman@gmail.com.
Insights
Cardiac index calculations can be inaccurate for infants. Determining z values is a more reliable method for evaluating cardiac output in children of all sizes.
Area of Science:
- Pediatric Cardiology
- Physiology
Background:
- Cardiac output is frequently normalized to body surface area (BSA) using the cardiac index for comparisons.
- The cardiac index may introduce significant errors when assessing cardiac output in small infants.
Purpose of the Study:
- To highlight the limitations of the cardiac index in pediatric populations.
- To propose an alternative method for evaluating cardiac output in children.
Main Methods:
- Review of existing methodologies for cardiac output assessment in pediatrics.
- Analysis of the accuracy of cardiac index versus z values for different pediatric age groups.
Main Results:
- The cardiac index demonstrates potential for large errors in small infants.
- Z values provide a more accurate and reliable assessment of cardiac output across diverse pediatric sizes.
Conclusions:
- The use of z values is recommended for evaluating cardiac output in children, particularly infants.
- Relying on the cardiac index for neonates and small infants may lead to misinterpretations of cardiovascular status.
Abstract:
When comparing cardiac outputs in children of different sizes, or deciding on the normality of these outputs, we often convert the absolute output to the output per m2 body surface area-the cardiac index. For small infants, this leads to potentially large errors. The best way to evaluate these outputs is to determine their z values.
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