Abstract 18025: Systematic Screening is Necessary to Detect Post-operative Thrombosis and Evaluate Risk in Children Undergoing Cardiac Surgery: A Prospective Observational Study
Bibliographic record
Abstract
Introduction: Postoperative thrombosis in children undergoing cardiac surgery with cardiopulmonary bypass (CPB) is a frequent, under-diagnosed and clinically detrimental complication. Methods: Pediatric patients were prospectively enrolled before surgery with CPB in an observational cohort study. Children <1 year old and cyanotic patients were oversampled. All subjects had serial lab assessment of hemostatic status and standardized vascular ultrasound for surveillance of post-operative thrombosis. Eligible non-enrolled patients were retrospectively reviewed as concurrent controls without study surveillance. All imaging findings underwent blinded adjudication to confirm the presence and clinical importance of identified thrombi. Results: Of 400 enrolled patients (54% males, 55% <1 year, 25% cyanotic), 398 (99%) completed the study, and 339 (85%) had protocol vascular ultrasound prior to or within 1 week of hospital discharge. Post-operative thrombosis was diagnosed in 99 study patients (25%) vs. 10% of the 1,019 control patients (p<0.001). Clinical evaluation alone missed 59% of all postoperative thrombi and 20% of clinically important thrombi. Multivariable factors associated with higher odds of postoperative thrombosis in study patients included 4 factors reflective of reduced heparin sensitivity and/or anticoagulation levels during CPB (Table). Postoperative thrombosis was associated with longer ICU stay (5 vs. 2 days, p=0.008), longer hospital stay (6 vs. 10 days, p<0.001), increased odds of reintervention or post-operation ECMO (OR: 2.7, p=0.005) and mortality (OR: 5.9, p=0.002). Conclusions: Given the poor performance of relying on clinical suspicion for detecting post-operative thrombosis, children <1 year old undergoing surgery with CPB should be systematically screened for thrombosis post-operatively. Individualization of thromboprophylaxis should consider both preoperative clinical factors and heparin sensitivity.
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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 | 0.003 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".