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Research: A predictive scoring system for small diaphragmatic defects in infants with congenital diaphragmatic hernia

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Research: A predictive scoring system for small diaphragmatic defects in infants with congenital diaphragmatic hernia

Pediatr Surg Int

. 2022 Nov 28;39(1):4.

 doi: 10.1007/s00383-022-05287-9. https://pubmed.ncbi.nlm.nih.gov/36441244/

A predictive scoring system for small diaphragmatic defects in infants with congenital diaphragmatic hernia

Keita Terui 1Kouji Nagata 2Masaya Yamoto 3Masahiro Hayakawa 4Hiroomi Okuyama 5Shoichiro Amari 6Akiko Yokoi 7Taizo Furukawa 8Kouji Masumoto 9Tadaharu Okazaki 10Noboru Inamura 11Katsuaki Toyoshima 12Yuhki Koike 13Manabu Okawada 14Yasunori Sato 15Noriaki Usui 16

Affiliations expand

Abstract

Purpose: To develop a predictive score for small diaphragmatic defects in infants with congenital diaphragmatic hernia (CDH) for determining thoracoscopic surgery indication.

Methods: The Japanese CDH Study Group cohort was randomly divided into derivation (n = 397) and validation (n = 396) datasets. Using logistic regression, a prediction model and weighted scoring system for small diaphragmatic defects were created from derivation dataset and validated with validation dataset.

Results: Six weighted variables were selected: no hydramnios, 1 point; 1 min Apgar score of 5-10, 1 point; apex type of the lung (left lung is detected radiographically in apex area), 1 point; oxygenation index < 8, 1 point; abdominal nasogastric tube (tip of the nasogastric tube is detected radiographically in the abdominal area), 2 points; no right-to-left flow of ductus arteriosus, 1 point. In validation dataset, rates of small diaphragmatic defects for Possible (0-3 points), Probable (4-5 points), and Definite (6-7 points) groups were 36%, 81%, and 94%, respectively (p < 0.001). Additionally, sensitivity, specificity, positive predictive value, and C statistics were 0.78, 0.79, 0.88, 0.76, and 0.45, 0.94, 0.94, 0.70 for Probable and Definite groups, respectively.

Conclusion: Our scoring system effectively predicted small diaphragmatic defects in infants with CDH.

Keywords: Congenital abnormalities; Congenital diaphragmatic hernia; Diaphragm; Minimally invasive surgical procedures; Statistical models.

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