Khan Abid, Tanny Sharman Tan, Perkins Elizabeth J, Hunt Rodney W, Hutson John M, King Sebastian K, Jones Bryn, Teague Warwick J
Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia.
Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia.
J Pediatr Surg. 2017 Dec;52(12):1952-1955. doi: 10.1016/j.jpedsurg.2017.08.046. Epub 2017 Sep 2.
Duodenal atresia (DA) is associated with cardiac defects that may have perioperative care implications. Standard preoperative care includes echocardiography to identify such cardiac defects, but this dogma has been challenged. We aimed to assess selective and selective strategies for preoperative echocardiography in DA patients.
Single-center retrospective review of neonates with DA over a 16-year period was performed. Data included preoperative cardiovascular and respiratory examination, chest x-ray, and echocardiography. We compared the current nonselective versus selective strategies, limiting preoperative echocardiogram to those in whom: (1) cardiac or respiratory or chest x-ray examination was abnormal, or (2) cardiac or respiratory examination was abnormal. Sensitivity, specificity, positive and negative predictive values were compared with chi-square tests.
Seventy-one of 109 (65%) consecutive neonates with DA underwent preoperative echocardiography according to a nonselective, physician-determined strategy. Forty of 71 (56%) patients had cardiac defects, including 16/40 (27%) major defects. Sixteen additional postoperative echocardiograms revealed 2 missed major defects. In the same cohort, selective strategies would have performed 17-24% fewer echocardiograms without significant detriment in performance.
All strategies considered missed some major cardiac defects. A selective strategy, determining DA patients not requiring preoperative echocardiogram, could reduce the number of echocardiograms performed without compromising patient safety.
Retrospective study.
Level II.
十二指肠闭锁（DA）与心脏缺陷相关，这可能对围手术期护理有影响。标准的术前护理包括超声心动图以识别此类心脏缺陷，但这一教条受到了挑战。我们旨在评估DA患者术前超声心动图的选择性和非选择性策略。
对16年间患有DA的新生儿进行单中心回顾性研究。数据包括术前心血管和呼吸检查、胸部X光和超声心动图。我们比较了当前的非选择性与选择性策略，将术前超声心动图限制在以下人群：（1）心脏或呼吸或胸部X光检查异常，或（2）心脏或呼吸检查异常。敏感性、特异性、阳性和阴性预测值通过卡方检验进行比较。
按照非选择性、医生决定的策略，109例连续DA新生儿中有71例（65%）接受了术前超声心动图检查。71例患者中有40例（56%）存在心脏缺陷，其中16/40例（27%）为主要缺陷。另外16例术后超声心动图发现2例漏诊的主要缺陷。在同一队列中，选择性策略可减少17 - 24%的超声心动图检查，且对检查效果无显著不利影响。
所有考虑的策略都漏诊了一些主要心脏缺陷。一种选择性策略，即确定不需要术前超声心动图检查的DA患者，可以减少超声心动图检查的数量，同时不影响患者安全。
回顾性研究。
二级。
