A clinical prediction model to estimate the risk for coarctation of the aorta in the presence of a patent ductus arteriosus.

Soslow JH, Kavanaugh-McHugh A, Wang L, Saurers DL, Kaushik N, Killen SA, Parra DA
J Am Soc Echocardiogr. 2013 26 (12): 1379-87

PMID: 24070640 · PMCID: PMC3915292 · DOI:10.1016/j.echo.2013.08.016

BACKGROUND - Diagnosing coarctation of the aorta (CoA) in the presence of a patent ductus arteriosus (PDA) may require observation until PDA closure. The aim of this study was to create a model incorporating previously published indices to estimate the probability of neonatal CoA in the presence of a PDA.

METHODS - A retrospective "investigation" cohort of 80 neonates was divided into two groups: (1) neonates with PDA and suspicion for CoA requiring observation to confirm the presence or absence of CoA and (2) neonates with PDA and confirmed diagnosis of either CoA or unobstructed aortic arch. Multivariate logistic regression was used to create the coarctation probability model (CPM), which was used to calculate a neonate's probability of CoA. The CPM was validated internally using bootstrapping and subsequently validated prospectively using a "validation" cohort of 74 neonates with PDA.

RESULTS - The CPM had an area under the receiver operating characteristic curve of 0.96 and demonstrated good clinical significance in the risk stratification of neonates with PDA and CoA. No neonate with a CPM probability of <15% had CoA after PDA closure. Neonates with CPM probability < 15% were classified at low risk, between 15% and 60% at moderate risk, and >60% at high risk for CoA.

CONCLUSIONS - On the basis of these results, the authors recommend measurement of the CPM in all neonates with PDA. Those with CPM probability < 15% no longer require observation, which could decrease observation in as many as half of neonates with unobstructed aortic arches; those with CPM probabilities between 15% and 60% require follow-up imaging, while those with CPM probabilities > 60% should be observed as inpatients until PDA closure.

Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

MeSH Terms (18)

Aortic Coarctation Causality Comorbidity Data Interpretation, Statistical Decision Support Techniques Ductus Arteriosus, Patent Female Humans Incidence Infant, Newborn Male Prognosis Proportional Hazards Models Reproducibility of Results Risk Assessment Sensitivity and Specificity Tennessee Ultrasonography

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