Distribution and Clinical Signs of Venous, Arterial and Intracardiac Clots After Pediatric Cardiac Surgery.
Bibliographic record
Abstract
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.
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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 | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 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".