Neurological complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease.
Neurological complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease.
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DOI：
10.1017/s1047951108002977
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发表时间：
2008-12
影响因子：
1
通讯作者：
Stellin G
中科院分区：
文献类型：
--
作者：
Bird GL;Jeffries HE;Licht DJ;Wernovsky G;Weinberg PM;Pizarro C;Stellin G
并发症是与疾病或医疗保健干预相关的事件或事件，偏离了期望的事件过程，并且可能导致次优结果或与次优结果相关。并发症并不一定代表违反护理标准，构成医疗过失或医疗事故。手术或手术并发症是指以下情况发生的任何并发症，无论其原因如何：(1) 在医院内或院外手术或干预后 30 天内，或 (2) 手术或干预后同一住院期间 30 天内发生。手术和手术并发症包括该时间间隔内的术中/术中并发症和术后/术后并发症。儿科和先天性心脏病多社会数据库委员会列出了与先天性心脏病患者治疗相关的并发症的综合列表，涉及心脏、肺、肾、血液、感染、神经、胃肠和内分泌系统，以及与麻醉和灌注管理以及胸腔器官移植相关的并发症。本手稿的目的是检查手术发病率的定义，因为它们与神经系统特别相关。这些具体的定义和术语将用于在许多独立的数据库中以通用语言跟踪与手术和经导管干预以及其他形式的治疗相关的发病率。虽然先天性心脏缺陷手术后可能会出现神经损伤和不良神经发育结果，但现在人们认识到神经结果的大部分变异与患者特定因素而不是手术因素更相关。此外，对术前和术后神经系统发病率的识别需要大量的程序和成像方式来获取和分析，而这些程序和成像方式可能需要大量资源来获取和分析，并且对于各个中心之间“采样率”的变化知之甚少或描述甚少。这项工作的目的是为先天性心脏手术和干预后的神经系统并发症提出一套初步的共识定义。鉴于迄今为止在理解方面取得的巨大进步以及尚未发生的进步，这一努力被明确认为只是必须保持迭代的过程的第一步。该列表是基于系统的并发症概要的一部分，可能有助于标准化术语，并可能加强先天性心脏畸形患者发病率的研究和量化。护理先天性心脏病患者的临床医生可以使用此列表作为数据库、提高质量的举措、报告并发症以及比较治疗策略。
A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval. The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrine systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to the neurological system. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases. Although neurological injury and adverse neurodevelopmental outcome can follow procedures for congenital cardiac defects, much of the variability in neurological outcome is now recognized to be more related to patient specific factors rather than procedural factors. Additionally, the recognition of pre and postoperative neurological morbidity requires procedures and imaging modalities that can be resource-intensive to acquire and analyze, and little is known or described about variations in “sampling rate” from centre to centre. The purpose of this effort is to propose an initial set of consensus definitions for neurological complications following congenital cardiac surgery and intervention. Given the dramatic advances in understanding achieved to date, and those yet to occur, this effort is explicitly recognized as only the initial first step of a process that must remain iterative. This list is a component of a systems-based compendium of complications that may help standardize terminology and possibly enhance the study and quantification of morbidity in patients with congenital cardiac malformations. Clinicians caring for patients with congenital cardiac disease may be able to use this list for databases, initiatives to improve quality, reporting of complications, and comparing strategies of treatment.