Praditukrit Aninthita, Wongwaitaweewong Kanjarut, Sangsupawanich Pasuree, Roymanee Supaporn, Jarutach Jirayut, Buntharikpornpun Rujira, Puttharak Suppalak
Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
PLoS One. 2025 Jun 2;20(6):e0325044. doi: 10.1371/journal.pone.0325044. eCollection 2025.
Cardiac catheterization, which is essential for clinical diagnosis and treatment, carries certain risks in pediatric patients, including complications such as loss of pulse, internal bleeding, vessel rupture, and subcutaneous hematoma. We investigated vascular complications in pediatric cardiac patients undergoing catheterization and developed a scoring system to predict these risks. We investigated pediatric patients aged <15 years who underwent cardiac catheterization at a tertiary hospital between January 2017 and December 2019 and developed a statistical model identifying the key factors influencing the risk of complications based on complication frequency, patient demographics, and treatment types. The identified key factors were body weight, procedure type, and maximum sheath size in the arterial-side-to-body-weight ratio. Using the scores determined by the model, participants were categorized into low-, intermediate-, and high-risk groups. The effectiveness of the model was assessed based on accuracy, alignment with real outcomes, and the ability to distinguish between cases with and without complications. Of the 390 patients, 6.2% experienced complications after cardiac catheterization. Transient pulse loss was the predominant complication (72%), followed by subcutaneous hematoma (12%) and bleeding (16%). In the development dataset, the vascular complication rates were 1.8%, 6.8%, and 26.1% in the low-, intermediate-, and high-risk groups, respectively. The likelihood ratios for vascular complications in the low-, intermediate-, and high-risk groups were 0.27 (95% confidence interval [CI]: 0.07, 0.81; P = 0.014), 1.12 (95% CI: 0.42, 2.67; P = 0.828), and 5.38 (95% CI: 2.23, 12.33; P < 0.001), respectively. Our model based on body weight, procedure type, and sheath size-to-body weight ratio accurately predicted vascular complications in pediatric cardiac catheterization. As one of the first studies to identify these risk factors, this study highlights the model's potential applicability to support risk stratification-based clinical decision-making. Further validation in diverse clinical settings is needed to confirm its generalizability and predictive performance.
心导管检查对于临床诊断和治疗至关重要，但在儿科患者中存在一定风险，包括脉搏消失、内出血、血管破裂和皮下血肿等并发症。我们调查了接受心导管检查的儿科心脏病患者的血管并发症情况，并开发了一种评分系统来预测这些风险。我们调查了2017年1月至2019年12月在一家三级医院接受心导管检查的15岁以下儿科患者，并根据并发症发生率、患者人口统计学特征和治疗类型建立了一个统计模型，以确定影响并发症风险的关键因素。确定的关键因素是体重、手术类型以及动脉侧鞘管最大尺寸与体重的比值。根据该模型确定的分数，将参与者分为低风险、中风险和高风险组。基于准确性、与实际结果的一致性以及区分有无并发症病例的能力对该模型的有效性进行了评估。在390例患者中，6.2%在心导管检查后出现并发症。短暂性脉搏消失是主要并发症（72%），其次是皮下血肿（12%）和出血（16%）。在开发数据集中，低风险、中风险和高风险组的血管并发症发生率分别为1.8%、6.8%和26.1%。低风险、中风险和高风险组血管并发症的似然比分别为0.27（95%置信区间[CI]：0.07，0.81；P = 0.014）、1.12（95%CI：0.42，2.67；P = 0.828）和5.38（95%CI：2.23，12.33；P < 0.001）。我们基于体重、手术类型和鞘管尺寸与体重比值的模型准确预测了儿科心导管检查中的血管并发症。作为首批识别这些风险因素的研究之一，本研究强调了该模型在支持基于风险分层的临床决策方面的潜在适用性。需要在不同临床环境中进行进一步验证，以确认其普遍性和预测性能。
