Development of a Clinical Decision Support System for the Detection of SIRS after Surgery for Congenital Heart Disease

Background: Systemic inflammatory response syndrome (SIRS) is a common phenomenon after pediatric cardiac surgery for congenital heart disease, affecting one-third of children and significantly prolonging PICU stay. Several factors, such as cardiopulmonary bypass (CPB) time or fresh frozen plasma (FFP) supplementation, pose a potential risk for the development of SIRS in patients after cardiac surgery.

Method: We evaluated a self-developed knowledge-based, interoperable clinical decision support system (CDSS) for SIRS detection on a pediatric intensive care unit (PICU), reusing routine data, transformed into an interoperable format (open EHR). Here, we presented the results of the secondary analysis of the subgroup of patients with congenital heart disease.

Results: From August 2018 to Mrch2019, 168 PICU patients aged 0 to 18 years who had received informed consent were evaluated by experts and the new CDSS for the presence of SIRS. Cardiac surgery was the reason for admission to the PICU in 46% (78/168) of patients. Also, 65% of these patients after cardiac surgery (51/78) experienced at least one episode of SIRS according to IPSCC criteria during their stay in the PICU. Expert evaluation of the PDMS data revealed 126 SIRS episodes during the PICU stay; the sensitivity of the CDSS in detecting SIRS episodes was 96% and the specificity was 71%.

Conclusion: The established CDSS seemed to a valuable tool for the automated detection of SIRS after cardiothoracic surgery for CHD. We identified several factors for further improvement of specificity of the CDSS by integrating more data into the decision process. Despite the improvement of the CDSS for SIRS detection, next steps will be the development of CDSS for several organ dysfunction and failure.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2022