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Diagnostic Accuracy Prior to Congenital Heart Defect Surgery: A Multicenter Collaboration
Shobha S Natarajan1, Kasey Chaszczewski2, Chris Penney1
1Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Multicenter collaboration reduced diagnostic errors in pediatric congenital heart disease (CHD) echocardiography. Cognitive and imaging factors were common causes, highlighting the need for standardized approaches to improve surgical outcomes.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Quality Improvement
Background:
- Echocardiography is crucial for diagnosing congenital heart disease (CHD).
- Diagnostic errors in echocardiography can negatively impact surgical outcomes for pediatric patients.
Purpose of the Study:
- To explore reasons for diagnostic errors in pediatric echocardiography for CHD.
- To investigate patient- and center-specific factors associated with these errors.
- To demonstrate the benefits of a multicenter approach in reducing errors and improving surgical outcomes.
Main Methods:
- A collaborative initiative involving 14 pediatric echocardiography laboratories.
- Data collection on 1,476 patients undergoing two-ventricle repair.
- Virtual meetings for case discussion and process refinement.
Main Results:
- A mean error rate of 7.1% was observed across centers.
- 74% of errors were preventable, with cognitive (43%) and imaging (47%) factors being primary contributors.
- No significant associations were found between patient- or center-specific factors and error rates.
Conclusions:
- A multicenter approach is feasible and advantageous for addressing preoperative diagnostic errors in pediatric echocardiography.
- Variability in protocols and processes exists across centers.
- This collaborative model can drive improvements in diagnostic accuracy and surgical outcomes for CHD.
Background:
Echocardiography is the mainstay for diagnosing congenital heart disease (CHD). Diagnostic errors can lead to suboptimal surgical outcomes.
Objectives:
This multicenter pediatric echocardiography collaborative learning initiative explores reasons for diagnostic errors, investigates associations between patient- and center-specific factors and errors, and relays the benefits of a multicenter approach to decrease these errors as a first step to improve CHD surgical outcomes.
Methods:
Participating centers submitted diagnostic evaluations on patients prior to 2-ventricle repair into a central database. We held virtual meetings to revise variables and discuss cases to learn from each other.
Results:
Fourteen pediatric echocardiography laboratories entered data on 1,476 consecutive patients with specific cardiac diagnoses who underwent a two-ventricle repair over 11 months. The mean error rate across centers was 7.1% (103 errors, 17/126-6/125). Seventy-six (74%) errors were preventable or possibly preventable. Cognitive (43%) and imaging factors (47%) commonly contributed to these errors. Moderate to severe impact on postoperative outcomes occurred in 19 (25%) preventable or possibly preventable errors. There were no statistically significant associations between patient- or center-specific factors and errors.
Conclusions:
This work represents the feasibility and advantages of a multicenter approach to preoperative diagnostic errors. Variability existed in sedated protocols, number of echos needed, use of other modalities, and in other processes. Common anatomic areas were found. Rather than undertaking isolated, single-center projects, this collaborative is poised to learn about novel changes that would improve diagnostic accuracy across centers as a first step to advancing surgical outcomes for patients with CHD.
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