Faraoni et al reported a score predictive of postoperative mortality for a pediatric patient with congenital heart disease undergoing noncardiac surgery. This can help to identify a patient who may benefit from more aggressive management or a nonoperative management strategy. The authors are from Boston Children's Hospital and Harvard Medical School.
Patient selection: pediatric patient with congenital heart disease undergoing noncardiac surgery
Outcome: postoperative mortality
Parameters:
(1) emergency procedure
(2) severe congenital heart disease
(3) single ventricle physiology
(4) time since surgery in days
(5) inotropic support
(6) preoperative cardiopulmonary resuscitation (CPR)
(7) acute or chronic kidney disease
(8) mechanical ventilation
|
Parameter
|
Finding
|
Points
|
|
emergency procedure
|
no
|
0
|
|
|
yes
|
1
|
|
severe congenital heart disease
|
no
|
0
|
|
|
yes
|
1
|
|
single ventricle physiology
|
no
|
0
|
|
|
yes
|
|
|
time since surgery
|
<= 30 days
|
1
|
|
|
> 30 days
|
0
|
|
inotropic support
|
no
|
0
|
|
|
yes
|
1
|
|
preoperative CPR
|
no
|
0
|
|
|
yes
|
2
|
|
acute or chronic kidney disease
|
no
|
0
|
|
|
yes
|
3
|
|
mechanical ventilation
|
no
|
0
|
|
|
yes
|
4
|
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score 14
• The higher the score the greater the risk for mortality.
• A score >= 7 was considered high risk.
|
Score
|
Approximate Mortality
|
|
0 or 1
|
0%
|
|
2
|
1
|
|
3
|
1.8
|
|
4
|
4.5
|
|
5
|
7
|
|
6
|
9
|
|
7
|
15
|
|
8
|
23
|
|
9
|
35
|
|
10
|
48
|
|
> 10
|
> 50%
|
from Figure 1
Performance:
• The area under the ROC curve is reported as 0.83.
