Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA, USA.
Circ Cardiovasc Interv. 2011 Apr 1;4(2):188-94. doi: 10.1161/CIRCINTERVENTIONS.110.959262. Epub 2011 Mar 8.
The Congenital Cardiac Catheterization Project on Outcomes (C3PO) was established to develop outcome assessment methods for pediatric catheterization.
Six sites have been recording demographic, procedural and immediate outcome data on all cases, using a web-based system since February 2007. A sample of data was independently audited for validity and data completeness. In 2006, participants categorized 84 procedure types into 6 categories by anticipated risk of an adverse event (AE). Consensus and empirical methods were used to determine final procedure risk categories, based on the outcomes: any AE (level 1 to 5); AE level 3, 4, or 5; and death or life-threatening event (level 4 or 5). The final models were then evaluated for validity in a prospectively collected data set between May 2008 and December 31, 2009. Between February 2007 and April 2008, 3756 cases were recorded, 558 (14.9%) with any AE; 226 (6.0%) level 3, 4, or 5; and 73 (1.9%) level 4 or 5. General estimating equations models using 6 consensus-based risk categories were moderately predictive of AE occurrence (c-statistics: 0.644, 0.664, and 0.707). The participant panel made adjustments based on the collected empirical data supported by clinical judgment. These decisions yielded 4 procedure risk categories; the final models had improved discrimination, with c-statistics of 0.699, 0.725, and 0.765. Similar discrimination was observed in the performance data set (n=7043), with c-statistics of 0.672, 0.708, and 0.721.
Procedure-type risk categories are associated with different complication rates in our data set and could be an important variable in risk adjustment models for pediatric catheterization.
先天性心脏导管插入术结局项目（C3PO）的成立是为了开发儿科导管插入术的结局评估方法。
自 2007 年 2 月以来，6 个站点一直在使用基于网络的系统记录所有病例的人口统计学、程序和即时结局数据。对数据样本进行了独立审核，以确保其有效性和完整性。2006 年，参与者根据不良事件（AE）的预期风险，将 84 种程序类型分为 6 类。根据结局：任何 AE（1 级至 5 级）；AE 3 级、4 级或 5 级；以及死亡或危及生命的事件（4 级或 5 级），使用共识和经验方法确定最终程序风险类别。然后，在 2008 年 5 月至 2009 年 12 月 31 日期间收集的前瞻性数据集中，对最终模型进行了有效性评估。2007 年 2 月至 2008 年 4 月期间，共记录了 3756 例病例，其中 558 例（14.9%）出现任何 AE；226 例（6.0%）为 3 级、4 级或 5 级；73 例（1.9%）为 4 级或 5 级。使用 6 个基于共识的风险类别进行的一般估计方程模型对 AE 发生具有中度预测能力（C 统计量：0.644、0.664 和 0.707）。参与者小组根据收集到的经验数据进行了调整，并得到了临床判断的支持。这些决策产生了 4 个程序风险类别；最终模型的区分度有所提高，C 统计量分别为 0.699、0.725 和 0.765。在性能数据集（n=7043）中也观察到了类似的区分度，C 统计量分别为 0.672、0.708 和 0.721。
在我们的数据集中，程序类型风险类别与不同的并发症发生率相关，可能是儿科导管插入术风险调整模型中的一个重要变量。
