Distribution and Clinical Signs of Venous, Arterial and Intracardiac Clots After Pediatric Cardiac Surgery.
Notice bibliographique
Résumé
Abstract Abstract 3992 Poster Board III-928 Background Very little is known about the occurrence of venous and arterial clots after pediatric cardiac surgery. To date, no studies have explored the distribution of clots throughout the different limbs/organ systems in this patient population. Furthermore, because many clots are asymptomatic or have non-specific clinical signs, there is a lack of clinical suspicion contributing to under-diagnosis and under-treatment of many patients, potentially leading to serious consequences. Methods A total of 1,542 cardiac surgeries in patients 0-18 years from September 2004 to December 2007 were reviewed. Patients with clots identified in the early post-operative period (up to hospital discharge) were further investigated. Clots were classified according to their limb/organ and vascular system locations. Clots not associated with limb swelling, discoloration, pain, localized changes in temperature or peripheral pulses were classified as asymptomatic. Results A total of 204 patients (13.2%) experience at least 1 thrombotic event, 122 surgeries (7.9%) were associated with venous clots (53 lower limbs, 34 upper limbs, 16 hepatic/renal/portal veins, 29 inferior or superior vena cava and 56 jugular vein, brachiocephalic vein or cerebral veins). In the arterial system 32 (2.1%) surgeries were associated with arterial clots (20 lower limbs, 2 upper limbs and 12 carotid artery, brachiocephalic artery or cerebral arteries). A further, 20 surgeries (1.3%) were associated with either intracardiac clots, primary pulmonary clots, intra aortic clots, pulmonary veins or arteries clots. Clots in 2 or more vascular systems (venous, arterial or cardiac) were found in 22 patients (1.4%). A higher proportion of patients with arterial clots were found to have clots in the lower limbs compared to those with venous clots (69% vs. 45%, p=0.04) the reverse was true for clots in the upper limbs (7% vs. 27%, p=0.02). There were no differences between vascular systems in terms of proportion of patients with clots in the cerebral veins and arteries (35% vs. 45%, p=0.21). Patients with venous clots were more likely to have clots in multiple locations than patients with arterial clots (38% vs. 0%, p<0.001). Overall 22% of patients were asymptomatic (23% of patients with venous clots, 16% of patients with arterial clots and 22% of patients with cardiac clots). There was no significant differences in the proportion of asymptomatic clots by limbs/organ system for clots either in the arterial or venous system. Of the patients with thrombotic complications, 19 (1.2%) had a stroke (12 ischemic, 4 sinovenous, 3 hemorrhagic), 16 (1.0%) had a cerebral haemorrhage and 4 patients had a pulmonary embolism. Furthermore, 87 (43%) of patients with thrombosis required either thrombolysis with tissue plasminogen activator (tPa), reoperation, re-catheterization or died prior to hospital discharge. This composite outcome was more likely in patients with clots in multiple systems (OR: 1.9, p=0.02), clots in the arterial vascular system (OR: 2.6, p=0.02) and for patients with clots in the carotid artery, brachiocephalic artery or cerebral arteries (OR: 4.4, p=0.03). Asymptomatic clots were slightly less likely to be associated with complications (OR: 0.5, p=0.09). Conclusion After pediatric cardiac surgeries, venous clots tend to spread throughout the body while arterial clots congregated in the upper limbs and cerebral arteries. Because almost one in four clots after pediatric cardiac surgery are asymptomatic, a high-index of suspicion is recommended in this population. Disclosures: No relevant conflicts of interest to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».