Document Detail


Early postoperative prediction of cerebral damage after pediatric cardiac surgery.
MedLine Citation:
PMID:  12902107     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cerebral damage is a serious complication of pediatric cardiac surgery. Early prediction of actual risk can be useful in counseling of parents, and in early diagnosis and rehabilitation therapy. Also, if all children at risk could be identified therapeutic strategies to limit perioperative cerebral damage might be developed. The aim of this study is to create a mathematical model to predict risk of neurologic sequelae within 24 hours after surgery using simple and readily available clinical measurements. METHODS: The hospital records of 534 children after cardiac surgery were reviewed. Variables examined were age at operation, diagnosis, use of cardiopulmonary bypass, arterial and central venous oxygen saturation, serum glucose, lactate and creatine kinase, mean arterial pressure, and body temperature. The endpoint for each study patient was the occurrence or lack of occurrence of seizures, movement or developmental disorders, cerebral hemorrhage, infarction, hydrocephalus, or marked cerebral atrophy. Univariate and multivariate regression analyses were used to evaluate the predictive power of the investigated factors as well as to create a predictive model. RESULTS: In 6.26% of children symptoms of cerebral damage were found. Significant risk factors were age at surgery, more complex malformations, metabolic acidosis, and increased lactate (odds ratio: age, 0.882/yr [0.772-1.008]; complex malformations, 10.32 [1.32-80.28]; arterial pH more than 7.35 to 0.4 [0.18-0.89]; lactate -1.018 per mg/dL [1.006-1.03]). CONCLUSIONS: It is possible to quantify the risk of appearance of symptoms of cerebral damage after cardiac surgery within 24 hours using simple and readily available clinical measurements.
Authors:
Gerhard Trittenwein; Alessandra Nardi; Heike Pansi; Johann Golej; Gudrun Burda; Michael Hermon; Harald Boigner; Gregor Wollenek;
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  76     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-08-06     Completed Date:  2003-09-11     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  576-80     Citation Subset:  AIM; IM    
Affiliation:
Department of Neonatology and Pediatric Critical Care, PICU, and the ECMO Project, University of Vienna, Austria. g.trittenwien@a1.net
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Brain Diseases / epidemiology,  etiology*
Cardiac Surgical Procedures / adverse effects*,  methods
Cerebrovascular Circulation*
Child
Child, Preschool
Female
Follow-Up Studies
Heart Defects, Congenital / diagnosis,  mortality,  surgery*
Humans
Incidence
Infant
Infant, Newborn
Male
Multivariate Analysis
Odds Ratio
Pediatrics
Postoperative Complications / epidemiology*
Postoperative Period
Predictive Value of Tests
Probability
ROC Curve
Registries
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Analysis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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