Year: 2015
Type: article
Study design: Observational Study
Abstract: To study the performance of the TIES as compared to the VIS. A single-centred retrospective study was conducted in children undergoing cardiac surgery with Cardiopulmonary bypass (CBP) between September 2010 and May 2011. The average and maximum VIS at 24 and 48 hours (VIS avg 24, VIS max 24, VIS max 48, VIS avg 48) and TIES were calculated. The performance of these scores to predict primary clinical outcome-- either death, Cardiopulmonary resuscitation, extra-corporeal membrane oxygenation (ECMO) before hospital discharge and secondary outcomes—prolonged length of invasive mechanical ventilation, length of intensive care unit(ICU) stay and hospital stay were calculated. 167 separate admissions included 37 (22.2%) neonates and 65 (41.3%) infants with a mean age of 2.9 (6.0) years. Twenty percent had higher complexity operations with a RACHS-1 category of 4-6. The TIES predicted the primary outcome (6 of 167 cases) with an AUC 0.92 (0.86, 0.97). The unadjusted odds ratio for a poor outcome was OR 42 (4.8, 369.6)]. The TIES score best predicted prolonged ventilation with an AUC of 0.88 (0.81, 0.95) compared to VIS avg 24 - 0.73 (0.64, 0.82) [p = 0.0001], VIS max 24 - 0.74 (0.66, 0.83) [p = 0.0011], VIS avg 48 - 0.74 (0.65, 0.82) [p < 0.0001], VIS max 48 - 0.67 (0.58, 0.77) [p < 0.001]. TIES was the best predictor of prolonged mechanical ventilation with an adjusted OR of 13.6 (3.9, 47.8) at a cut off of 14.7. None of the other scores significantly predicted prolonged ventilation after adjusting for covariates in a multiple regression. The TIES score best predicted freedom from mechanical ventilation with an adjusted-hazard ratio of Cox proportional hazard model of 0.97 (0.96, 0.99) [p = 0.01]. Similarly, the adjusted odds of a prolonged CVICU stay was predicted by the TIES score with an OR of ≥ 12.7 (3.51, 45.7) at a cut off of 14.7. The other scores which predicted a prolonged CVICU stay were - VIS avg 24 ≥4.5 OR 4.3(1.3, 14.1); VIS max 24 ≥4.8 OR 7.3(2.2, 24.2); VISavg48 ≥3.1 OR 3.5(1.1, 10.7). The odds of a prolonged hospital stay were 4 (1.37, 11.66) and 12.2 (2.5, 60.9) for VIS avg 48 and TIES at cut offs of 3.1 and 14.7 respectively. The TIES score best predicted discharge from the ICU and hospital with an adjusted Hazard Ratio of 0.96(0.94, 0.98)[p < 0.001] and 0.98(0.96,0.99)[p < 0.024]. The TIES score performed well and warrants prospective validation across larger numbers of patients, and across institutions.
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,890
OpenAlex ID: W2296898789