Predictive Model Identifies Patients Under Age One with a High Risk of Developing Hospital-Acquired Thrombosis

Hospital-acquired venous thrombosis (HAT) in children with congenital and acquired heart disease may be life-threatening. Children under age one are at highest risk and strategies to prevent HAT are lacking. The researchers performed a cohort study to develop a risk prediction model for HAT in babies by examining all admissions to the Cardiac Center at CHOP from September 2013 through December 2016 in infants less than one year of age during which a new HAT developed. Controls included all admissions without thrombosis in patients under one year of age for the same time period. Of the 1995 admissions, HAT developed in 83. Patients with prior thrombosis, younger age, chylothorax, single ventricle physiology, cardiac surgery, sepsis, central venous catheter and femoral catheter site were at highest risk. From this data, a risk prediction model was created with greater than 50 percent sensitivity and 97 percent specificity. Of patients identified by the model, over 50 percent went on to develop HAT. This model will inform further studies using prophylaxis with anticoagulants in infants with high risk of HAT. Therese M. Giglia, Leslie Raffini, et al. "Predictive Model for Hospital-Acquired Thrombosis in Pediatric Cardiac Patients Under One Year of Age," presented at the American College of Cardiology 67th Annual Scientific Session & Expo 2018.


Social Risk Factors Impact Hospital Readmission for Children with Congenital Heart Disease

Prolonged hospitalization and readmission for children with congenital heart disease (CHD) can increase risk for infection, impede development and increase costs. Social determinants of hospitalization and readmission are known for adult cardiac patients, but not for children with CHD, who are particularly vulnerable to the developmental impacts of hospitalization. The researchers examined records for 219 patients who underwent infant cardiac surgery with cardiopulmonary bypass. Cumulative social risk (racial/ethnic minority, Medicaid insurance, non-English speaking, maternal age at birth, regional socioeconomic status, distance from an outpatient cardiology clinic) was divided into high social risk vs low social risk, and risk of morbidity by procedure was ranked. Social risk groups did not differ on presence of genetic syndrome or single ventricle physiology. Interactions between social risk and morbidity score were identified for number of readmissions to age one and readmission days to age two. Comparisons showed that at low morbidity scores, patients with high social risk had more readmissions and greater number of readmission days than those at low social risk. High social risk also predicted significantly worse adherence to cardiology appointments and lower developmental scores. Social risk factors impact readmission rates and days for CHD patients with low risk of morbidity by procedure. Abby Demianczyk, et al. "Social Risk Factors Impact Hospital Readmission for Children with Congenital Heart Disease," presented at the American College of Cardiology 67th Annual Scientific Session & Expo 2018.

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