Modern risk scales in pediatrics and pediatric cardiac surgery as tools for assessing the quality of medical care

Abstract

Introduction. The review presents the characteristics of modern risk scales in pediatrics. A comparative analysis of the advantages and disadvantages of risk scales in pediatric cardiac surgery has been carried out. Early detection of high-risk patients was shown to be the basis for the prevention of adverse outcomes after cardiac surgery. The capabilities of the Aristotle School (Aristotle Basic Complexity (ABC) Score have been established as a tool for assessing the quality of surgical treatment of children with congenital heart defects (CHD). Its determinants are mortality, the complexity of the postoperative period, and the technical complexity of the operation. The correlation between the values of the ABC scale and its determinants was evaluated. If the values of all three determinants exceeded the upper limit of the 95% confidence interval (CI), the patient was included in the high-risk group. The quality of treatment was assessed by the performance index (IP). A close correlation between ABC and its determinants has been revealed. For the ABC school, a high accuracy of the prognosis of death, complications, and technical complexity was established with an optimal threshold value of 6.5 points. Patients with ABC above the threshold were more likely to die. The IP was 0.56, similar indicators of foreign clinics ranged from 0.46 to 0.62 points. 
 Conclusion. The basic Aristotle scale and new risk stratification scales after cardiac surgery in children are effective systems for evaluating the results of surgical treatment of CHD patients of different levels of complexity can be used to determine the quality of surgical treatment and identify high-risk groups.