Hoff Hannah, Quary Sharon, Keesari Rohali, Oster Matthew E
Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.
Department of Pediatrics, Northside Hospital, Atlanta, Georgia.
Am J Perinatol. 2025 Apr;42(5):674-682. doi: 10.1055/a-2416-5637. Epub 2024 Sep 17.
In 2018, an expert panel recommended two key modifications to the most used algorithm for screening neonates for critical congenital heart disease (CCHD). Our aim was to evaluate the outcomes of the modified algorithm compared with those of the original algorithm in a real-world setting.We compared the performance characteristics of an original CCHD algorithm used to screen term neonates at a large hospital system between October 26, 2018, and October 15, 2020, and the recommended modified algorithm used between October 15, 2020, and June 30, 2022. We calculated sensitivity, specificity, false positive rate, proportion of false positives with non-CCHD illness, and error rates of test administration and interpretation for each algorithm.Sensitivity was not significantly different between the modified algorithm compared with the original algorithm (40.00 vs. 12.50%, ≥0.99), but specificity was lower (and hence false positive rate was higher) in the modified algorithm (99.91 vs. 99.98%, < 0.001). Despite a higher false positive rate in the modified algorithm, the proportion of false positives with significant non-CCHD illness was similar (36.47 vs. 28.57%, ≥0.99), a finding that translated to an increase in the number of cases of significant non-CCHD illness detected (11 cases out of 32,178 screens vs. 2 cases out of 32,984 screens). Error rates of test administration and interpretation were similar between the two algorithms.In this limited study, the modified algorithm for CCHD screening using pulse oximetry had a higher false positive rate than that of the original American Academy of Pediatrics algorithm. However, this higher rate led to an increased overall number of cases detected of significant non-CCHD illness. · Experts recommend two changes to the American Academy of Pediatrics-endorsed CCHD screen.. · This study evaluates the new algorithm for screening.. · The new algorithm detects at least as many cases as the original.. · There was no significant difference in test sensitivity for CCHD.. · The new algorithm has a statistically higher false positive rate..
2018年，一个专家小组建议对用于筛查新生儿严重先天性心脏病（CCHD）的最常用算法进行两项关键修改。我们的目的是在实际环境中评估修改后的算法与原始算法的效果。我们比较了2018年10月26日至2020年10月15日在一家大型医院系统中用于筛查足月儿的原始CCHD算法，以及2020年10月15日至2022年6月30日使用的推荐修改算法的性能特征。我们计算了每种算法的敏感性、特异性、假阳性率、非CCHD疾病的假阳性比例以及测试管理和解读的错误率。与原始算法相比，修改后的算法敏感性无显著差异（40.00%对12.50%，≥0.99），但修改后的算法特异性较低（因此假阳性率较高）（99.91%对99.98%，<0.001）。尽管修改后的算法假阳性率较高，但有显著非CCHD疾病的假阳性比例相似（36.47%对28.57%，≥0.99），这一结果转化为检测到的有显著非CCHD疾病病例数增加（32178次筛查中有11例，而32984次筛查中有2例）。两种算法的测试管理和解读错误率相似。在这项有限的研究中，使用脉搏血氧饱和度仪进行CCHD筛查的修改后算法比美国儿科学会的原始算法有更高的假阳性率。然而，这一较高的比率导致检测到的有显著非CCHD疾病的病例总数增加。· 专家建议对美国儿科学会认可的CCHD筛查进行两项更改。· 本研究评估了新的筛查算法。· 新算法检测到的病例数至少与原始算法一样多。· CCHD的测试敏感性无显著差异。· 新算法的假阳性率在统计学上更高。
