Pediatric cardiology
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Pediatric cardiology · Aug 2013
Multicenter Study Comparative StudyCharacterization of extracorporeal membrane oxygenation for pediatric cardiac arrest in the United States: analysis of the kids' inpatient database.
To characterize the overall use, cost, and outcomes of extracorporeal membrane oxygenation (ECMO) as an adjunct to cardiopulmonary resuscitation (CPR) among hospitalized infants and children in the United States, retrospective analysis of the 2000, 2003, and 2006 Kids' Inpatient Database (KID) was performed. All CPR episodes were identified; E-CPR was defined as ECMO used on the same day as CPR. Channeling bias was decreased by developing propensity scores representing the likelihood of requiring E-CPR. ⋯ Median LOS and charges are considerably greater for E-CPR survivors with C-CPR survivors. In this retrospective administrative database analysis, E-CPR did not significantly influence survival. Further study is needed to improve outcomes and to identify patients most likely to benefit from this resource-intensive therapy.
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Pediatric cardiology · Jun 2013
Multicenter StudySurgical volume and center effects on early mortality after pediatric cardiac surgery: 25-year North American experience from a multi-institutional registry.
Mortality after pediatric cardiac surgery varies among centers. Previous research suggests that surgical volume is an important predictor of this variation. This report characterizes the relative contribution of patient factors, center surgical volume, and a volume-independent center effect on early postoperative mortality in a retrospective cohort study of North American centers in the Pediatric Cardiac Care Consortium (up to 500 cases/center/year). ⋯ In conclusion, center-specific variation exists but is only partially explained by operative volume. Low-risk operations are safely performed at centers in all volume categories, whereas regionalization or other quality improvement strategies appear to be warranted for moderate- and high-risk operations. Potentially preventable mortality occurs at centers in all volume categories studied, so referral or regionalization strategies must target centers by observed outcomes rather than assume that volume predicts quality.
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Pediatric cardiology · Feb 2013
Multicenter Study Comparative StudyRhythm and conduction analysis of patients with acute rheumatic fever.
Various rhythm and conduction abnormalities can develop in acute rheumatic fever. This study investigated rhythm and conduction abnormalities in children with acute rheumatic fever using a standard 12-lead electrocardiogram and 24-h rhythm Holter recordings. This multicenter retrospective study, performed between August 2011 and March 2012, enrolled 73 consecutive children with acute rheumatic fever. ⋯ Whereas some patients with carditis exhibited no arrhythmic evidence on standard electrocardiograms, complete atrioventricular block, supraventricular tachycardia, and Mobitz type 1 block were observed on 24-h Holter recordings. A positive correlation also was observed between the presence of premature contractions and serum levels of acute-phase reactants (p = 0.03; r = 0.62). These findings led to the conclusion that rhythm and conduction disorders in acute rheumatic fever are more common than previously thought.
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Pediatric cardiology · Feb 2013
Multicenter Study Comparative StudyA multi-institutional analysis of inpatient treatment for supraventricular tachycardia in newborns and infants.
This study aimed to examine practice patterns in the inpatient medical treatment of newborns and infants with supraventricular tachycardia (SVT) using the Pediatric Health Information System (PHIS) database, a large, multi-institutional administrative database. A retrospective examination of pediatric hospital discharge data was performed during the study period from January 2003 to September 2008. Data were extracted from the index hospitalization of all individuals younger than 1 year with the principal discharge diagnosis of SVT. ⋯ The five most commonly used antiarrhythmic drugs, in order of decreasing frequency of use, were propranolol, digoxin, amiodarone, flecainide, and sotalol. The median hospital stay for the group was 4 days, and this value increased as a function of the number of antiarrhythmic drugs used (median, 7 days for three or more agents) and the need for intensive care (median, 6 days). The information provided in this study helps to define common practice patterns and should allow caregivers to provide meaningful expectations to families regarding their potential treatment course and to anticipate the hospital length of stay.
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Pediatric cardiology · Jan 2013
Multicenter StudyEffects of race, ethnicity, and gender on surgical mortality in hypoplastic left heart syndrome.
Information is limited regarding the effect of race, ethnicity, and gender on the outcomes of the three palliative procedures for hypoplastic left heart syndrome (HLHS). This study examined the effects of race, ethnicity, gender, type of admission, and surgical volume on in-hospital mortality associated with palliative procedures for HLHS between 1998 and 2007 using data from the University HealthSystem Consortium. According to the data, 1,949 patients underwent stage 1 palliation (S1P) with a mortality rate of 29 %, 1,279 patients underwent stage 2 palliations (S2P) with a mortality rate of 5.4 %, and 1,084 patients underwent stage 3 palliation (S3P) with a mortality rate of 4.1 %. ⋯ No racial differences with S3P were observed. The risk factors for increased mortality at S1P were black and "other" race, smaller surgical volume, and early surgical era. The risk factors for increased in-hospital mortality with S2P were black race and Hispanic ethnicity.