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Z Scores for Pediatric Echocardiography Dimensions Adjusted for Body Size, BMI, and Age
Jonathan Lauzon-Schnittka1, Virginie Plante1, Nagib Dahdah2
1Département de Pédiatrie, Université de Sherbrooke and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Canada (J.L.-S., V.P., F.D.).
Insights
New Z score equations improve pediatric echocardiogram interpretation by accounting for body size, body mass index, and age, reducing diagnostic bias in children.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Biostatistics
Background:
- Pediatric echocardiogram measurements require normalization for body size.
- Age and abnormal body habitus can confound interpretations.
- Existing normalization methods may not fully account for these factors.
Purpose of the Study:
- Develop Z score equations for pediatric echocardiography dimensions.
- Ensure equations are free from confounding effects of body size, BMI, and age.
- Improve diagnostic accuracy in pediatric cardiology.
Main Methods:
- Retrospective cross-sectional study using data from >20,000 children.
- Utilized a generalized additive model for location, scale, and shape (GAMLSS).
- Modeled measurements based on sex, height, weight, BMI, and age.
Main Results:
- Proposed Z scores showed less bias than body surface area models.
- Reduced bias observed in overweight, young, and early school-aged children.
- New equations offer improved normalization for diverse pediatric populations.
Conclusions:
- Z score equations minimize confounding from body size, BMI, and age.
- Enhanced interpretation accuracy for pediatric echocardiograms.
- Potential to improve diagnostic and therapeutic decisions in pediatric cardiology.
Background:
Cardiovascular dimensions measured during pediatric echocardiograms must be normalized for body size. However, other variables may confound their interpretation, such as age and abnormal body habitus. This retrospective cross-sectional study of the Canadian Congenital and Pediatric Cardiology Research Network aimed to create Z score equations for commonly measured dimensions in pediatric 2-dimensional echocardiography that were free of residual confounding effects of body size, body mass index, and age.
Methods:
The reference sample consisted of >20 000 children without heart disease from 9 institutions who underwent clinical echocardiography that was reported as normal. A generalized additive model for location, scale, and shape (GAMLSS) was used to model the expected distributions of measurements as a function of sex, height, weight, body mass index, and age.
Results:
Compared with a model that only considered body surface area, the proposed Z scores demonstrated less bias in subgroups of overweight, young, and early school-aged children.
Conclusions:
The proposed Z score equations may improve diagnostic and therapeutic accuracy by ensuring that body size, body mass index, and age do not confound the interpretation of measurements.
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