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Risk-stratification enables accurate single-center outcomes assessment in congenital diaphragmatic hernia (CDH)
- Source :
- Journal of pediatric surgery. 54(5)
- Publication Year :
- 2019
-
Abstract
- Background Management of CDH is highly variable from center to center, as are patient outcomes. The purpose of this study was to examine risk-stratified survival and extracorporeal membrane oxygenation (ECMO) rates at a single center, and to determine whether adverse outcomes are related to patient characteristics or management. Methods A retrospective single-center review of CDH patients was performed, and outcomes compared to those reported by the CDH Study Group (CDHSG) registry. Patient demographics, disparities, and clinical characteristics were examined to identify unique features of the cohort. A model derived using the registry that estimates probability of ECMO use or death in CDH newborns was used to risk-stratify patients and assess mortality rates. Observed over expected (O/E) ECMO use rates were calculated to measure whether “excess” or “appropriate” ECMO use was occurring. Results There were 81 CDH patients treated between 2004–2017, and 5034 in the CDHSG registry. Mortality in ECMO-treated patients was higher than the registry. Socioeconomic variables were not significantly associated with outcomes. The strongest predictors of mortality were ECMO use and early blood gas variables. The risk model accurately predicted ECMO use with a c-statistic of 0.79. Compared with the registry, the disparity in mortality rates was greatest for moderate-risk patients. O/E ECMO use was highest in low and moderate-risk patients. Conclusions ECMO use is a more consistent predictor of mortality than CDH severity at a single center, and there is relative overuse of ECMO in lower-risk patients. Risk stratification allows for more accurate institutional assessment of mortality and ECMO use, and other centers could consider such an adjusted analysis to identify opportunities for outcomes improvement. Level of Evidence III.
- Subjects :
- Male
medicine.medical_specialty
Patient demographics
medicine.medical_treatment
Medical Overuse
Single Center
Risk Assessment
Severity of Illness Index
03 medical and health sciences
0302 clinical medicine
Extracorporeal Membrane Oxygenation
Risk Factors
030225 pediatrics
Outcome Assessment, Health Care
Extracorporeal membrane oxygenation
medicine
Humans
Registries
Retrospective Studies
business.industry
Mortality rate
Infant, Newborn
Congenital diaphragmatic hernia
General Medicine
Evidence-based medicine
medicine.disease
Survival Rate
surgical procedures, operative
030220 oncology & carcinogenesis
Pediatrics, Perinatology and Child Health
Risk stratification
Emergency medicine
Cohort
Surgery
Female
Blood Gas Analysis
business
Hernias, Diaphragmatic, Congenital
Subjects
Details
- ISSN :
- 15315037
- Volume :
- 54
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Journal of pediatric surgery
- Accession number :
- edsair.doi.dedup.....72c7b357e9d72b281e696bb8f385dae1