{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T02:05:24Z","timestamp":1789005924593,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T00:00:00Z","timestamp":1724284800000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01 HD093660"],"award-info":[{"award-number":["R01 HD093660"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017640","name":"Texas Department of State Health Services","doi-asserted-by":"publisher","award":["NU50DD000102"],"award-info":[{"award-number":["NU50DD000102"]}],"id":[{"id":"10.13039\/100017640","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017640","name":"Texas Department of State Health Services","doi-asserted-by":"publisher","award":["HHS 00096260001"],"award-info":[{"award-number":["HHS 00096260001"]}],"id":[{"id":"10.13039\/100017640","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Traditional strategies for grouping congenital heart defects (CHDs) using birth defect registry data do not adequately address differences in expected clinical consequences between different combinations of CHDs. We report a lesion\u2010specific classification system for birth defect registry\u2013based outcome studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>For Core Cardiac Lesion Outcome Classifications (C\u2010CLOC) groups, common CHDs expected to have reasonable clinical homogeneity were defined. Criteria based on combinations of Centers for Disease and Control\u2010modified British Pediatric Association (BPA) codes were defined for each C\u2010CLOC group. To demonstrate proof of concept and retention of reasonable case counts within C\u2010CLOC groups, Texas Birth Defect Registry data (1999\u20132017 deliveries) were used to compare case counts and neonatal mortality between traditional vs. C\u2010CLOC classification approaches.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>C\u2010CLOC defined 59 CHD groups among 62,262 infants with CHDs. Classifying cases into the single, mutually exclusive C\u2010CLOC group reflecting the highest complexity CHD present reduced case counts among lower complexity lesions (e.g., 86.5% of cases with a common atrium BPA code were reclassified to a higher complexity group for a co\u2010occurring CHD). As expected, C\u2010CLOC groups had retained larger sample sizes (i.e., representing presumably better\u2010powered analytic groups) compared to cases with only one CHD code and no occurring CHDs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>This new CHD classification system for investigators using birth defect registry data, C\u2010CLOC, is expected to balance clinical outcome homogeneity in analytic groups while maintaining sufficiently large case counts within categories, thus improving power for CHD\u2010specific outcome association comparisons. Future outcome studies utilizing C\u2010CLOC\u2010based classifications are planned.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.2393","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T10:18:02Z","timestamp":1724321882000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Enhancing the Classification of Congenital Heart Defects for Outcome Association Studies in Birth Defects Registries"],"prefix":"10.1002","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2180-2198","authenticated-orcid":false,"given":"Sara\u00a0B.","family":"Stephens","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health The University of Texas Health Science Center at Houston  Houston Texas USA"},{"name":"Division of Pediatric Cardiology, Department of Pediatrics Texas Children's Hospital and Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6406-4247","authenticated-orcid":false,"given":"Renata\u00a0H.","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2710-6257","authenticated-orcid":false,"given":"Keila\u00a0N.","family":"Lopez","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics Texas Children's Hospital and Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett\u00a0R.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology New York\u2010Presbyterian and Columbia University Irving Medical Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela\u00a0E.","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Medical Genetics Unit Mass General for Children and Harvard University School of Medicine  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2884-2835","authenticated-orcid":false,"given":"Charles\u00a0J.","family":"Shumate","sequence":"additional","affiliation":[{"name":"Texas Department of State Health Services  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8318-4049","authenticated-orcid":false,"given":"Wendy\u00a0N.","family":"Nembhard","sequence":"additional","affiliation":[{"name":"Arkansas Center for Birth Defects Research and Prevention and Arkansas Reproductive Health Monitoring System, Fay Boozman College of Public Health, Department of Epidemiology University of Arkansas for Medical Sciences  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8056-0934","authenticated-orcid":false,"given":"Shaine\u00a0A.","family":"Morris","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics Texas Children's Hospital and Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5874-4155","authenticated-orcid":false,"given":"A.\u00a0J.","family":"Agopian","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.1879"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.1549"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2004.03.039"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2010.10.071"},{"key":"e_1_2_10_6_1","first-page":"219","article-title":"Analysis of Surgical Mortality for Congenital Heart Defects Using RACHS\u20101 Risk Score in a Brazilian Single Center","volume":"31","author":"Cavalcante C. 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