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External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery

OBJECTIVE: Independent temporal external validation of the improving partial risk adjustment in surgery model (PRAIS-2) to predict 30-day mortality in patients undergoing paediatric cardiac surgery. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Paediatric cardiac surgery....

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Autores principales: Cocomello, Lucia, Caputo, Massimo, Cornish, Rosie, Lawlor, Deborah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703410/
https://www.ncbi.nlm.nih.gov/pubmed/33247009
http://dx.doi.org/10.1136/bmjopen-2020-039236
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author Cocomello, Lucia
Caputo, Massimo
Cornish, Rosie
Lawlor, Deborah
author_facet Cocomello, Lucia
Caputo, Massimo
Cornish, Rosie
Lawlor, Deborah
author_sort Cocomello, Lucia
collection PubMed
description OBJECTIVE: Independent temporal external validation of the improving partial risk adjustment in surgery model (PRAIS-2) to predict 30-day mortality in patients undergoing paediatric cardiac surgery. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Paediatric cardiac surgery. INTERVENTION: PRAIS-2 validation was carried out using a two temporally different single centre (Bristol, UK) cohorts: Cohort 1 surgery undertaken from April 2004 to March 2009 and Cohort 2 from April 2015 to July 2019. For each subject PRAIS-2 score was calculated according to the original formula. PARTICIPANTS: A total of 1352 (2004-2009) and 1197 (2015-2019) paediatric cardiac surgical procedures were included in the Cohort 1 and Cohort 2, respectively (median age at the procedure 6.3 and 7.1 months). PRIMARY AND SECONDARY OUTCOME MEASURES: PRAIS-2 performance was assessed in terms of discrimination by means of ROC (receiver operating characteristic) curve analysis and calibration by using the calibration belt method. RESULTS: PRAIS-2 score showed excellent discrimination for both cohorts (AUC 0.72 (95%CI: 0.65 to 0.80) and 0.88 (95%CI: 0.82 to 0.93), respectively). While PRAIS-2 was only marginally calibrated in Cohort 1, with a tendency to underestimate risk in lowrisk and overestimate risk in high risk procedures (P-value = 0.033), validation in Cohort 2 showed good calibration with the 95% confidence belt containing the bisector for predicted mortality (P-value = 0.143). We also observed good prediction accuracy in the non-elective procedures (N = 483;AUC 0.78 (95%CI 0.68 to 0.87); Calibration belt containing the bisector (P-value=0.589). CONCLUSIONS: In a single centre UK-based cohort, PRAIS-2 showed excellent discrimination and calibration in predicting 30-day mortality in paediatric cardiac surgery including in those undergoing non-elective procedures. Our results support a wider adoption of PRAIS-2 score in the clinical practice.
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spelling pubmed-77034102020-12-09 External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery Cocomello, Lucia Caputo, Massimo Cornish, Rosie Lawlor, Deborah BMJ Open Cardiovascular Medicine OBJECTIVE: Independent temporal external validation of the improving partial risk adjustment in surgery model (PRAIS-2) to predict 30-day mortality in patients undergoing paediatric cardiac surgery. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Paediatric cardiac surgery. INTERVENTION: PRAIS-2 validation was carried out using a two temporally different single centre (Bristol, UK) cohorts: Cohort 1 surgery undertaken from April 2004 to March 2009 and Cohort 2 from April 2015 to July 2019. For each subject PRAIS-2 score was calculated according to the original formula. PARTICIPANTS: A total of 1352 (2004-2009) and 1197 (2015-2019) paediatric cardiac surgical procedures were included in the Cohort 1 and Cohort 2, respectively (median age at the procedure 6.3 and 7.1 months). PRIMARY AND SECONDARY OUTCOME MEASURES: PRAIS-2 performance was assessed in terms of discrimination by means of ROC (receiver operating characteristic) curve analysis and calibration by using the calibration belt method. RESULTS: PRAIS-2 score showed excellent discrimination for both cohorts (AUC 0.72 (95%CI: 0.65 to 0.80) and 0.88 (95%CI: 0.82 to 0.93), respectively). While PRAIS-2 was only marginally calibrated in Cohort 1, with a tendency to underestimate risk in lowrisk and overestimate risk in high risk procedures (P-value = 0.033), validation in Cohort 2 showed good calibration with the 95% confidence belt containing the bisector for predicted mortality (P-value = 0.143). We also observed good prediction accuracy in the non-elective procedures (N = 483;AUC 0.78 (95%CI 0.68 to 0.87); Calibration belt containing the bisector (P-value=0.589). CONCLUSIONS: In a single centre UK-based cohort, PRAIS-2 showed excellent discrimination and calibration in predicting 30-day mortality in paediatric cardiac surgery including in those undergoing non-elective procedures. Our results support a wider adoption of PRAIS-2 score in the clinical practice. BMJ Publishing Group 2020-11-27 /pmc/articles/PMC7703410/ /pubmed/33247009 http://dx.doi.org/10.1136/bmjopen-2020-039236 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Cardiovascular Medicine
Cocomello, Lucia
Caputo, Massimo
Cornish, Rosie
Lawlor, Deborah
External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery
title External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery
title_full External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery
title_fullStr External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery
title_full_unstemmed External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery
title_short External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery
title_sort external validation of the improving partial risk adjustment in surgery (prais-2) model for 30-day mortality after paediatric cardiac surgery
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703410/
https://www.ncbi.nlm.nih.gov/pubmed/33247009
http://dx.doi.org/10.1136/bmjopen-2020-039236
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