Prenatal screening for major congenital heart disease: assessing performance by combining national cardiac audit with maternity data

被引:56
作者
Gardiner, Helena M. [1 ,2 ,3 ,4 ,5 ]
Kovacevic, Alexander [3 ,5 ,6 ]
van der Heijden, Laila B. [3 ,5 ]
Pfeiffer, Patricia W. [7 ]
Franklin, Rodney C. G. [3 ]
Gibbs, John L. [8 ]
Averiss, Ian E.
LaRovere, Joan M. [3 ,9 ]
机构
[1] Univ London Imperial Coll Sci Technol & Med, London, England
[2] Queen Charlottes & Chelsea Hosp, London W6 0XG, England
[3] NHS Fdn Trust, Royal Brompton & Harefield Hosp, Dept Paediat Cardiol, London, England
[4] Univ Texas Houston, Texas Fetal Ctr, Houston, TX 77030 USA
[5] Univ London Imperial Coll Sci Technol & Med, Fac Med, IRDB, London, England
[6] Univ Dusseldorf, Dusseldorf, Germany
[7] Boston Childrens Hosp, Cardiovasc Clin Outcomes Grp, Boston, MA USA
[8] NICOR, Naperville, IL USA
[9] Boston Childrens Hosp, Div Cardiovasc Crit Care, Boston, MA USA
关键词
Congenital Heart Disease; DIAGNOSIS; TELEMEDICINE; POPULATION; SURGERY; ENGLAND;
D O I
10.1136/heartjnl-2013-304640
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective Determine maternity hospital and lesion-specific prenatal detection rates of major congenital heart disease (mCHD) for hospitals referring prenatally and postnatally to one Congenital Cardiac Centre, and assess interhospital relative performance (relative risk, RR). Methods We manually linked maternity data (3 hospitals prospectively and another 16 retrospectively) with admissions, fetal diagnostic and surgical cardiac data from one Congenital Cardiac Centre. This Centre submits verified information to National Institute for Cardiovascular Outcomes Research (NICOR-Congenital), which publishes aggregate antenatal diagnosis data from infant surgical procedures. We included 120198 unselected women screened prospectively over 11years in 3 maternity hospitals (A, B, C). Hospital A: colocated with fetal medicine, proactive superintendent, on-site training, case-review and audit, hospital B: on-site training, proactive superintendent, monthly telemedicine clinics, and hospital C: sonographers supported by local obstetrician. We then studied 321 infants undergoing surgery for complete transposition (transposition of the great arteries (TGA), n=157) and isolated aortic coarctation (CoA, n=164) screened in hospitals A, B, C prospectively, and 16 hospitals retrospectively. Results 385 mCHD recorded prospectively from 120198 (3.2/1000) screened women in 3 hospitals. Interhospital relative performance (RR) in Hospital A:1.68 (1.4 to 2.0), B:0.70 (0.54 to 0.91), C:0.65 (0.5 to 0.8). Standardised prenatal detection rates (funnel plots) demonstrating inter-hospital variation across 19 hospitals for TGA (37%, 0.00 to 0.81) and CoA (34%, 0.00 to 1.06). Conclusions Manually linking data sources produced hospital-specific and lesion-specific prenatal mCHD detection rates. More granular, rather than aggregate, data provides meaningful feedback to improve screening performance. Automatic maternal and infant record linkage on a national scale, requires verified, prospective maternity audit and integration of health information systems.
引用
收藏
页码:375 / 382
页数:8
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