Selective approach to preoperative echocardiography in esophageal atresia
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In brief
In brief
This retrospective study of 115 neonates with esophageal atresia evaluated selective preoperative echocardiography strategies based on clinical examination and chest x-ray findings. A selective approach using absence of murmur, cyanosis, and abnormal respiratory findings achieved 97% negative predictive value, potentially reducing unnecessary echocardiograms by 22% while maintaining patient safety.
Written by the GCMD Library team from the article.
Abstract
Purpose
Preoperative echocardiography is used routinely in neonates with esophageal atresia to identify patients in whom congenital cardiac disease will impact upon anesthetic and surgical decision-making. We aimed to determine the suitability of selective preoperative echocardiography.
Methods
We performed a single-center retrospective review of neonates with esophageal atresia over 6 years (2010–2015) at our tertiary pediatric institution. Data included preoperative clinical examination, chest x-ray, and echocardiography. Endpoints were cardiovascular, respiratory, radiological, and echocardiography findings. Selective strategies were assessed using sensitivity, specificity, positive predictive value, and negative predictive value.
Results
We identified 115 neonates with esophageal atresia. All underwent preoperative echocardiography. Cardiac defects were identified in 49/115 (43%) (major 9/115, moderate 4/115). Sensitivity, specificity, positive predictive value, and negative predictive value of abnormal clinical and radiologic assessment for major and moderate cardiac defects were 92%, 25%, 13%, 96%; for clinical examination alone were 92%, 25%, 14%, 96%; for absence of murmur, cyanosis, and abnormal respiratory examination were 92%, 28%, 13%, 97%. Selective strategies reduce echocardiograms performed by 22%.
Conclusion
Selective strategies allow for identification of neonates with esophageal atresia who may have deferral of echocardiogram unill after surgery. Selection may improve timeliness of care and resource utilization, without compromising patient safety.