Department of Pediatrics, University of Hawaii, Honolulu, HI, USA.
Department of Pediatrics, Division of Pediatric Cardiology, All Children's Hospital, St Petersburg, FL, USA.
Cardiol Young. 2023 Oct;33(10):1813-1818. doi: 10.1017/S1047951122003110. Epub 2022 Oct 6.
Published guidelines for sports restriction for children with a bicuspid aortic valve remain controversial. We sought to describe practice variation and factors influencing sports restrictions in these children.
This retrospective single-centre study included children (7-18 years old) with an isolated bicuspid aortic valve at baseline from 1 January, 2005 to 31 December, 2014. Sports restrictions, factors potentially influencing decision-making, and outcomes were collected. Descriptive statistics and multivariable mixed-effects logistic regression models were performed with providers and patients as random effects. Provider variation was estimated using intraclass correlation coefficients. Odds ratios, 95% confidence intervals, and p-values were reported from the models.
In 565 encounters (253 children; 34 providers), 41% recommended no sports restrictions, 40% recommended high-static and high-dynamic restrictions, and 19% had no documented recommendations. Based on published guidelines, 22% of children were inappropriately restricted while 30% were not appropriately restricted. The paediatric cardiology provider contributed to 37% of observed practice variation (p < 0.001). Sports restriction was associated with older age, males, greater ascending aorta z-score, and shorter follow-up interval. There were no aortic dissections or deaths and one cardiac intervention.
Physicians frequently fail to document sports restrictions for children with a bicuspid aortic valve, and documented recommendations often conflict with published guidelines. Despite this, no adverse outcomes occurred. Providers accounted for a significant proportion of the variation in sports restrictions. Further research to provide evidence-based guidelines may improve provider compliance with activity recommendations in this population.
针对具有二叶式主动脉瓣的儿童的运动限制指南仍存在争议。我们旨在描述这些儿童的实践差异和影响运动限制的因素。
这项回顾性单中心研究纳入了 2005 年 1 月 1 日至 2014 年 12 月 31 日期间基线时患有孤立性二叶式主动脉瓣的儿童（7-18 岁）。收集了运动限制、潜在影响决策的因素以及结局。采用提供者和患者为随机效应的描述性统计和多变量混合效应逻辑回归模型。使用组内相关系数估计提供者差异。模型报告了比值比、95%置信区间和 p 值。
在 565 次就诊（253 名儿童；34 名提供者）中，41%建议无运动限制，40%建议高静动态限制，19%无书面建议。根据发表的指南，22%的儿童受到不当限制，而 30%的儿童未受到适当限制。儿科心脏病学提供者对观察到的实践差异的贡献为 37%（p<0.001）。运动限制与年龄较大、男性、升主动脉 z 评分较高和随访间隔较短有关。无主动脉夹层或死亡病例，仅有 1 例心脏介入。
医生经常未能为患有二叶式主动脉瓣的儿童记录运动限制，而记录的建议常常与发表的指南相冲突。尽管如此，并未发生不良结局。提供者在运动限制方面的差异中占很大比例。进一步的研究提供循证指南可能会提高提供者在该人群中对活动建议的依从性。
