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套管治疗先天性心脏病风险调整方法II
Brian P Quinn1, Lauren C Gunnelson1, Sarah G Kotin1
1Department of Cardiology, Boston Children's Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.).
Circulation. Cardiovascular interventions
|January 23, 2024
概括
一个新的风险调整模型,CHARM II,改善了小儿心脏导管治疗中不良事件的比较. 它考虑了复杂的患者因素和新技术,为机构和运营商提供了更公平的评估.
科学领域:
- 心脏病学 心脏病学
- 医疗信息学 医疗信息学
- 儿科健康 儿科健康
背景情况:
- 目前对先天性心脏导管治疗的风险调整指标已经过时了.
- 新的程序,技术和患者子组需要更新的方法.
- 现有的指标不能充分捕捉案例组合的复杂性.
研究的目的:
- 开发一种新的风险调整方法,用于先天性心脏导管.
- 引入一个临床上有意义的不良事件结果.
- 将患者风险的现代理解纳入其中.
主要方法:
- 从诊断和干预性先天性心脏导管病例 (患者≤18岁,≥2.5公斤) 收集的数据.
- 使用的推导队列 (2014-2017年) 和验证队列 (2019-2020年).
- 临床上有意义的不良事件定义为严重程度≥3b;分层分为三级 (3a/b/c).
主要成果:
- 分析了导出 (15,224个案例) 和验证 (9462个案例) 队列.
- 临床上有意义的不良事件发生率为4.5% (衍生) 和4.2% (验证).
- 最终的模型包括年龄<30天,先天性心脏导管类别中的程序风险和血液动力学脆弱性得分 (C-统计值0.70).
结论:
- CHARM II (先天性心脏病风险调整方法II) 是一种新的风险调整方法.
- CHARM II 能够公平地比较临床上有意义的不良事件.
- 该方法针对不同患者群体和儿科心脏导管治疗中的病例组合复杂性.
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