Poster Presentations: Wednesday, October 26, 2011 |

Pediatric Risk Stratification Method (PediaRiSM) for Postoperative Pulmonary Complications for Cardiothoracic Surgery: A Validity Study at the Philippine Heart Center FREE TO VIEW

Marisa Damian-Cabucana, MD; Beverly Dela Cruz, MD; Ma Nerissa De Leon, MD; Milagros Bautista, MD; Teresita De Guia, MD; Fernando Ayuyao, MD
Chest. 2011;140(4_MeetingAbstracts):846A. doi:10.1378/chest.1118014
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PURPOSE: A simple scoring system (PediaRISM) was proposed in 2008 , to predict post-operative pulmonary complications among children undergoing cardio-thoracic surgery. Variables independently predictive of post-operative complications were FVC < 80, blood pH < 7.35 and WBC > 12T per cubic mm. Risk assessment was categorized as low, moderate and high risk. The study aims to determine the validity of the ( PediaRISM ) for post-operative pulmonary complications for cardio-thoracic surgery.

METHODS: Risk classification for pulmonary complications performed among 6-18 years old was based on PediaRISM scoring system. Variables were age, sex, weight, pulmonary artery pressures, Forced spirometry , preoperative hemoglobin and platelet count, Bypass time and cross clamp time. A logistic regression analysis was done in adjusting for the effects of variables which shows significant association with post operative pulmonary complication. Validation of the risk scores in the reference paper was carried out using sensitivity, specificity, positive and negative predictive value using Kappa Test .

RESULTS: 104 children were assessed using PediaRiSM. There were 78 patients with post operative pulmonary complications . Pneumothorax and Atelactasis were the most common complications. Dependent variables identified as significant risk for morbidity were elevated pulmonary pressures,FEV1 <80, and high normal platelet count. PediaRiSM is still an independent predictor of post operative complications, (p = 0. 018). Risk of post operative pulmonary complications rises with increasing Pediarism Risk Score . Accuracy of PediaRiSM risk score category in predicting the occurrence of post operative pulmonary complications showed that high risk category score is highly specific (100.00), very low sensitivity ( 7.7%) positive predictive value = 100.0 and negative predictive value = 26.5 but the combination of moderate plus high risk category scores showed sensitivity of 67.9% and specificity of 84.6%, positive predictive value = 93 and negative predictive value = 46.8

CONCLUSIONS: This study validates the recently proposed risk stratification method (PediaRiSM) for post operative pulmonary complications for cardiothoracic surgery in children 6-18years old .

CLINICAL IMPLICATIONS: PediaRiSM provide risk category that can be used to predict the development of post operative pulmonary complications

DISCLOSURE: The following authors have nothing to disclose: Marisa Damian-Cabucana, Beverly Dela Cruz, Ma Nerissa De Leon, Milagros Bautista, Teresita De Guia, Fernando Ayuyao

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