1. An Empirically Derived Pediatric Cardiac Inotrope Score Associated With Pediatric Heart Surgery.
- Author
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Gupta P, Rettiganti M, Wilcox A, Vuong-Dac MA, Gossett JM, Imamura M, and Chakraborty A
- Subjects
- Age Factors, Bayes Theorem, Cardiotonic Agents adverse effects, Child, Preschool, Clinical Decision-Making, Computer Simulation, Dopamine administration & dosage, Epinephrine administration & dosage, Female, Heart Defects, Congenital diagnosis, Heart Defects, Congenital mortality, Heart Defects, Congenital physiopathology, Hospital Mortality, Humans, Infant, Infant, Newborn, Length of Stay, Male, Markov Chains, Milrinone administration & dosage, Monte Carlo Method, Nordefrin administration & dosage, Odds Ratio, Predictive Value of Tests, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Cardiac Surgical Procedures adverse effects, Cardiac Surgical Procedures mortality, Cardiotonic Agents administration & dosage, Decision Support Techniques, Drug Dosage Calculations, Heart Defects, Congenital surgery, Hemodynamics drug effects, Myocardial Contraction drug effects
- Abstract
We aimed to empirically derive an inotrope score to predict real-time outcomes using the doses of inotropes after pediatric cardiac surgery. The outcomes evaluated included in-hospital mortality, prolonged hospital length of stay, and composite poor outcome (mortality or prolonged hospital length of stay). The study population included patients <18 years of age undergoing heart operations (with or without cardiopulmonary bypass) of varying complexity. To create this novel pediatric cardiac inotrope score (PCIS), we collected the data on the highest doses of 4 commonly used inotropes (epinephrine, norepinephrine, dopamine, and milrinone) in the first 24 hours after heart operation. We employed a hierarchical framework by representing discrete probability models with continuous latent variables that depended on the dosage of drugs for a particular patient. We used Bayesian conditional probit regression to model the effects of the inotropes on the mean of the latent variables. We then used Markov chain Monte Carlo simulations for simulating posterior samples to create a score function for each of the study outcomes. The training dataset utilized 1030 patients to make the scientific model. An online calculator for the tool can be accessed at https://soipredictiontool.shinyapps.io/InotropeScoreApp. The newly proposed empiric PCIS demonstrated a high degree of discrimination for predicting study outcomes in children undergoing heart operations. The newly proposed empiric PCIS provides a novel measure to predict real-time outcomes using the doses of inotropes among children undergoing heart operations of varying complexity., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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