Improving the Safety of the Manchester Triage System for Children with Congenital Heart Disease

Abstract This study is a prospective evaluation of the validity of a Manchester Triage System (MTS) modification for detecting under-triaged pediatric patients with congenital heart disease (CHD). Children with CHD visiting the emergency unit of the Department of Pediatrics and Adolescent Medicine, Vienna General Hospital, in 2014 were included. The MTS modification updated the prioritization of patients with complex syndromic diseases, specific symptoms related to chronic diseases, decreased general condition (DGC), profound language impairment, unknown medical history, or special needs. A four-level outcome severity index based on diagnostic and therapeutic interventions, admission to hospital, and follow-up strategies, was defined as a reference standard for the correct clinical classification of the MTS urgency level. Of the 19,264 included children, 940 had CHD. Of this group, 266 fulfilled the inclusion criteria for the modified triage method. The MTS modification was significantly more often applied in under-triaged (65.9%) than correctly or over-triaged (25%) children with CHD (p-value χ²test <0.0001, OR 5.848 95% CI: 3.636-9.6).Conclusion: The MTS urgency level upgrade modification could reduce under-triage in children with CHD. Applying a safety strategy concept to the MTS could mitigate under-triage in such a high-risk patient group.

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Early detection of and intervention for two newborns with critical congenital heart disease using a specialized device as part of a screening system

SAGE Open Medical Case Reports ◽

10.1177/2050313x20926041 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2092604

Author(s):

René Gómez-Gutiérrez ◽

Héctor Cruz-Camino ◽

Consuelo Cantú-Reyna ◽

Adrián Martínez-Cervantes ◽

Diana Laura Vazquez-Cantu ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Early Detection ◽

Pulse Oximetry ◽

Congenital Heart ◽

Screening Program ◽

Disease Screening ◽

Therapeutic Interventions ◽

Critical Congenital Heart Disease ◽

Clinical Method

Screening for critical congenital heart disease is a clinical method used for their early detection using pulse oximetry technology. This, followed by a diagnostic confirmatory protocol, allows timely therapeutic interventions that improve the newborn’s outcome. According to Mexican birth statistics, approximately 18,000–21,000 neonates are born with a form of congenital heart disease each year, of which 25% are estimated to be critical congenital heart disease. We report two cases with an early critical congenital heart disease detection and intervention through an innovative critical congenital heart disease screening program implemented in two Mexican hospitals. They integrated a new automated pulse oximetry data analysis method and a comprehensive follow-up system (Cárdi-k®). Both cases were confirmed by echocardiogram, which served for an intervention in the first week of life, and the patients were discharged in good clinical condition. In addition, to the routine physical assessments, the critical congenital heart disease screening program (which includes echocardiogram for presumptive positive cases) should be implemented in a timely manner.

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Abstract 19890: Pre-operative Cerebral Hemodynamics From Birth Until Surgery in Neonates With Critical Congenital Heart Disease

Circulation ◽

10.1161/circ.132.suppl_3.19890 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Jennifer M Lynch ◽

John J Newland ◽

Madeline Winters ◽

David R Busch ◽

Ann L McCarthy ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

White Matter ◽

Congenital Heart ◽

White Matter Injury ◽

Therapeutic Interventions ◽

Metabolic Demand ◽

Critical Congenital Heart Disease ◽

Therapeutic Algorithms ◽

Increased Risk

Introduction: Neonates with critical congenital heart disease (CHD) exhibit a high prevalence of white matter injury (WMI). Recent work in neonates with hypoplastic left heart syndrome has shown that a longer wait from birth to surgery was associated with lower cerebral tissue oxygen saturations (StO2) on the morning of surgery and an increased risk for postoperative white matter injury (WMI). Understanding the daily preoperative changes in cerebral physiology during this vulnerable period may lead to new therapeutic algorithms aimed at prevention of WMI. Methods: Term neonates with critical CHD were recruited for this study. Frequency domain diffuse optical spectroscopy was employed to noninvasively quantify StO2. Daily StO2 measurements were made from day of recruitment until the day of surgery. Results: We studied 37 neonates with critical CHD. Operations were performed at 1-8 days of life. Non-elective reasons for timing of surgery resulted only in earlier surgery in this cohort. The subjects were placed in 2 groups depending on if they had a normal arch (N=20) or obstructed arch (N=17). In a linear mixed-effects model, StO2 decreased as a function of time from birth but was not specific to diagnostic group. Conclusions: Observed longitudinal daily decline in StO2 from birth until surgery supports our earlier findings and extends them to other groups of CHD. These results suggest that reported increases in risk for WMI with time-to-surgery could be due to mismatched oxygen delivery to metabolic demand. Therapeutic interventions such as increasing cerebral blood flow or decreasing cerebral oxygen demand may be considered when earlier surgery is not possible.

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Congenital heart disease in adults

The ESC Textbook of Intensive and Acute Cardiovascular Care ◽

10.1093/med/9780198849346.003.0059 ◽

2021 ◽

pp. 795-804

Author(s):

Susanna Price ◽

Brian F Keogh ◽

Lorna Swan

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Adult Congenital Heart Disease ◽

Disease Patient ◽

Therapeutic Interventions ◽

Clinical State ◽

Medical Attention ◽

Physiological Status ◽

Heart Disease Patient

The number of patients with congenital heart disease surviving to adulthood is increasing, with many requiring ongoing medical attention. Although recommendations are that these patients should be cared for in specialist centres, the clinical state of the acutely unwell patient may preclude transfer prior to the instigation of lifesaving treatment. Although the principles of resuscitation in this patient population differ little from those with acquired heart disease, the acutely unwell adult congenital heart disease patient presents a challenge, with potential pitfalls in examination, assessment/monitoring, and intervention. Keys to avoiding errors include: knowledge of the primary pathophysiology, any interventions that have been undertaken, residual lesions present (static or dynamic), and the normal physiological status for that patient-to determine the precise cause for the acute deterioration and to appreciate the effects (detrimental or otherwise) that any supportive and/or therapeutic interventions might have. Expert advice should be sought at the earliest opportunity.

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Heart failure in single right ventricle congenital heart disease: physiological and molecular considerations

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00518.2019 ◽

2020 ◽

Vol 318 (4) ◽

pp. H947-H965 ◽

Cited By ~ 1

Author(s):

Anastacia M. Garcia ◽

Jonathan-Thomas Beatty ◽

Stephanie J. Nakano

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Congenital Heart Disease ◽

Heart Disease ◽

Right Ventricle ◽

Congenital Heart ◽

Molecular Mechanisms ◽

Therapeutic Interventions ◽

Anatomy And Physiology ◽

Molecular Alterations

Because of remarkable surgical and medical advances over the past several decades, there are growing numbers of infants and children living with single ventricle congenital heart disease (SV), where there is only one functional cardiac pumping chamber. Nevertheless, cardiac dysfunction (and ultimately heart failure) is a common complication in the SV population, and pharmacological heart failure therapies have largely been ineffective in mitigating the need for heart transplantation. Given that there are several inherent risk factors for ventricular dysfunction in the setting of SV in addition to probable differences in molecular adaptations to heart failure between children and adults, it is perhaps not surprising that extrapolated adult heart failure medications have had limited benefit in children with SV heart failure. Further investigations into the molecular mechanisms involved in pediatric SV heart failure may assist with risk stratification as well as development of targeted, efficacious therapies specific to this patient population. In this review, we present a brief overview of SV anatomy and physiology, with a focus on patients with a single morphological right ventricle requiring staged surgical palliation. Additionally, we discuss outcomes in the current era, risk factors associated with the progression to heart failure, present state of knowledge regarding molecular alterations in end-stage SV heart failure, and current therapeutic interventions. Potential avenues for improving SV outcomes, including identification of biomarkers of heart failure progression, implications of personalized medicine and stem cell-derived therapies, and applications of novel models of SV disease, are proposed as future directions.

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