Abid Khan1, Sharman Tan Tanny2, Elizabeth J Perkins3, Rodney W Hunt4, John M Hutson5, Sebastian K King6, Bryn Jones7, Warwick J Teague8. 1. Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia. 2. Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia. 3. Neonatal Research Group, Murdoch Children's Research Institute, Melbourne, Australia. 4. Neonatal Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia. 5. Department of Paediatrics, University of Melbourne, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Urology, The Royal Children's Hospital, Melbourne, Australia. 6. Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia. 7. Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia. 8. Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia. Electronic address: Warwick.Teague@rch.org.au.
Abstract
BACKGROUND: Duodenal atresia (DA) is associated with cardiac defects that may have perioperative care implications. Standard preoperative care includes echocardiography to identify such cardiac defects, but this dogma has been challenged. We aimed to assess selective and selective strategies for preoperative echocardiography in DA patients. METHODS: Single-center retrospective review of neonates with DA over a 16-year period was performed. Data included preoperative cardiovascular and respiratory examination, chest x-ray, and echocardiography. We compared the current nonselective versus selective strategies, limiting preoperative echocardiogram to those in whom: (1) cardiac or respiratory or chest x-ray examination was abnormal, or (2) cardiac or respiratory examination was abnormal. Sensitivity, specificity, positive and negative predictive values were compared with chi-square tests. RESULTS: Seventy-one of 109 (65%) consecutive neonates with DA underwent preoperative echocardiography according to a nonselective, physician-determined strategy. Forty of 71 (56%) patients had cardiac defects, including 16/40 (27%) major defects. Sixteen additional postoperative echocardiograms revealed 2 missed major defects. In the same cohort, selective strategies would have performed 17-24% fewer echocardiograms without significant detriment in performance. CONCLUSIONS: All strategies considered missed some major cardiac defects. A selective strategy, determining DA patients not requiring preoperative echocardiogram, could reduce the number of echocardiograms performed without compromising patient safety. TYPE OF STUDY: Retrospective study. LEVEL OF EVIDENCE: Level II.
BACKGROUND:Duodenal atresia (DA) is associated with cardiac defects that may have perioperative care implications. Standard preoperative care includes echocardiography to identify such cardiac defects, but this dogma has been challenged. We aimed to assess selective and selective strategies for preoperative echocardiography in DA patients. METHODS: Single-center retrospective review of neonates with DA over a 16-year period was performed. Data included preoperative cardiovascular and respiratory examination, chest x-ray, and echocardiography. We compared the current nonselective versus selective strategies, limiting preoperative echocardiogram to those in whom: (1) cardiac or respiratory or chest x-ray examination was abnormal, or (2) cardiac or respiratory examination was abnormal. Sensitivity, specificity, positive and negative predictive values were compared with chi-square tests. RESULTS: Seventy-one of 109 (65%) consecutive neonates with DA underwent preoperative echocardiography according to a nonselective, physician-determined strategy. Forty of 71 (56%) patients had cardiac defects, including 16/40 (27%) major defects. Sixteen additional postoperative echocardiograms revealed 2 missed major defects. In the same cohort, selective strategies would have performed 17-24% fewer echocardiograms without significant detriment in performance. CONCLUSIONS: All strategies considered missed some major cardiac defects. A selective strategy, determining DA patients not requiring preoperative echocardiogram, could reduce the number of echocardiograms performed without compromising patient safety. TYPE OF STUDY: Retrospective study. LEVEL OF EVIDENCE: Level II.
Authors: Warwick J Teague; Matthew L M Jones; Leanne Hawkey; Ian M Smyth; Angelique Catubig; Sebastian K King; Gulcan Sarila; Ruili Li; John M Hutson Journal: Front Genet Date: 2018-11-09 Impact factor: 4.599
Authors: Matthew L M Jones; Gulcan Sarila; Pierre Chapuis; John M Hutson; Sebastian K King; Warwick J Teague Journal: Front Pharmacol Date: 2020-03-10 Impact factor: 5.810