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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.

JACC. Advances
|February 28, 2025
PubMed
Summary

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.

Keywords:
echocardiography (echo) laboratory (lab)pediatric diagnostic errorsquality improvement (QI)

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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.