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Evaluating the utility of routine screening catheterisation before interstage discharge of infants with
Katherine E Bates1, Andrew C Glatz2, Therese M Giglia2
1Department of Pediatrics and Communicable Diseases, Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI,USA.
Insights
Routine screening catheterization before discharge did not improve interstage outcomes in infants with univentricular defects. This evaluation showed no significant difference in adverse events between screening and usual care groups.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Interventional Cardiology
Background:
- Interstage mortality in infants with shunt-dependent univentricular defects often has unknown causes.
- A screening catheterization program was implemented to assess its impact on interstage outcomes.
Purpose of the Study:
- To determine if routine screening catheterization before neonatal discharge improves interstage outcomes in infants with shunt-dependent univentricular defects.
- To compare the effectiveness of screening catheterization versus usual care in predicting interstage adverse events.
Main Methods:
- A retrospective single-center review of a home monitoring program from December 2010 to June 2012.
- Composite scores for risk factors (physical examination/echocardiography, catheterization) and adverse events were created.
- Statistical analysis included sensitivity, specificity, and receiver operating characteristic curves to assess predictive ability.
Main Results:
- No significant differences in interstage adverse event frequency between the usual care (27 patients) and screening catheterization (32 patients) groups.
- Screening catheterization group had 100% catheterization before discharge, compared to 29.6% in usual care.
- Predictive values for adverse events showed moderate sensitivity and specificity, with areas under the ROC curve ranging from 0.56 to 0.66.
Conclusions:
- Screening catheterization provided a slight increase in sensitivity and specificity for predicting adverse events but did not alter their frequency.
- The minimal benefit of screening catheterization does not outweigh its known risks.
- Screening catheterizations are no longer recommended for this patient population.
Introduction:
Interstage mortality causes are often unknown in infants with shunt-dependent univentricular defects. For 2 years, screening catheterisation was encouraged before neonatal discharge to determine if routine evaluation improved interstage outcomes.
Methods:
Retrospective single-centre review of home monitoring programme from December, 2010 to June, 2012. Composite scores were created for physical examination/echocardiography risk factors; catheterisation risk factors; and interstage adverse events. Composite scores were compared between usual care and screening catheterisation groups. The ability of each risk factor composite to predict interstage adverse events, individually and in combination, was assessed with sensitivity, specificity, and receiver operating characteristic curves.
Results:
There were 27 usual care and 32 screening catheterisation patients. There were no significant differences between groups except rates of catheterisation before discharge (29.6 versus 100%, p < 0.001). Usual care patients who underwent catheterisation for clinical indications had higher intervention rates (37.5 versus 3.1%, p = 0.004). Physical examination/echocardiography risk factor frequency was similar, but usual care patients with catheterisation had a higher catheterisation risk factor frequency. Interstage adverse event frequency was similar (48.2 versus 53.1%, p = 0.7). For interstage adverse event prediction, sensitivity for the physical examination/echocardiography, catheterisation, and either risk factor composites was 53.3, 72, and 80%, respectively; specificity was 59, 60, and 48%. The area under the receiver operating characteristic curve was 0.56, 0.66, and 0.64.
Conclusion:
Screening catheterisation evaluation offered slightly increased sensitivity and specificity, but no difference in interstage adverse event frequency. Given this small advantage versus known risks, screening catheterisations are no longer encouraged.
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