Outcomes of emergent cardiac catheterization following pediatric cardiac surgery
Bibliographic record
Abstract
BACKGROUND: Although there is agreement of the importance of cardiac catheterization, especially interventional procedures, cardiac catheterization in postoperative critical care unit (CCU) period is often debated. The focus of this study was to explore the indications for and determinants of outcome after cardiac catheterization in this setting. METHODS: Between March 2004 and October 2006, 49 children (2.8% of cardiac surgeries) underwent 62 catheterizations before discharge from the CCU. Morphological, surgical, and catheterization data were accrued and analyzed using parametric competing risks models and multivariable risk-hazard analysis. RESULTS: Median age at surgery was 167 days (0-13.5 years) and time to catheterization was 8.5 (0-84) days following surgery. Catheterization procedures were either interventional (n = 35) or noninterventional (n = 27). Children who required a more urgent investigation following initial surgery more often had deployment of a stent at catheterization (P = 0.01) or subsequent surgical pulmonary artery augmentation (P < 0.01). Surgical reoperation was required following 23 (37%) catheterizations and was more common following index surgery involving a cavopulmonary shunt. Overall mortality was high (43%). Delayed invasive investigation beyond 2-3 weeks (P = 0.04) or a splinted sternum (P < 0.001) were risk factors for death. In addition, reoperation after a noninterventional catheterization predicted worse survival (P < 0.001). CONCLUSIONS: The need for invasive investigation in the immediate CCU period is associated with a poor outcome, especially when the investigation is delayed or an intervention is not possible. Identification of at-risk patients may improve outcomes. Best outcomes follow expedient catheterization with definitive management (often stent deployment or pulmonary artery augmentation).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".