A clinical prediction model to estimate the risk for coarctation of the aorta in the presence of a patent ductus arteriosus.
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.
Department of Pediatrics, Thomas P. Graham Jr. Division of Pediatric Cardiology, Vanderbilt University Medical Center, and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee. Electronic address: jonathan.h.soslow@vanderbilt.edu.
Jonathan H
JH
Soslow
Ann
A
Kavanaugh-McHugh
Li
L
Wang
Daniel L
DL
Saurers
Neeru
N
Kaushik
Stacy A S
SA
Killen
David A
DA
Parra
D001017:Aortic Coarctation / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015984:Causality; D015897:Comorbidity; D003627:Data Interpretation, Statistical; D003661:Decision Support Techniques; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D013714:Tennessee / Q000453:epidemiology; D014463:Ultrasonography / Q000379:methods / Q000706:statistics & numerical data*
CA/DT; CPM; CSA; Carotid artery–to–distal transverse arch; Carotid artery–to–subclavian artery; CoA; Coarctation of the aorta; Coarctation probability model; Congenital heart disease; DT; Distal transverse arch; I/D; Isthmus–to–descending aorta; Logistic regression model; NICU; Neonatal intensive care unit; Neonate; PDA; PGE; Patent ductus arteriosus; Prostaglandin E(1)