{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T01:13:54Z","timestamp":1787793234994,"version":"build-2784847793"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Current metrics used to adjust for case mix complexity in congenital cardiac catheterization are becoming outdated due to the introduction of novel procedures, innovative technologies, and expanding patient subgroups. This study aims to develop a risk adjustment methodology introducing a novel, clinically meaningful adverse event outcome and incorporating a modern understanding of risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Data from diagnostic only and interventional cases with defined case types were collected for patients \u226418 years of age and \u22652.5 kg at all Congenital Cardiac Catheterization Project on Outcomes participating centers. The derivation data set consisted of cases performed from 2014 to 2017, and the validation data set consisted of cases performed from 2019 to 2020. Severity level 3 adverse events were stratified into 3 tiers by clinical impact (3a\/b\/c); the study outcome was clinically meaningful adverse events, severity level \u22653b (3bc\/4\/5).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      The derivation data set contained 15\u2005224 cases, and the validation data set included 9462 cases. Clinically meaningful adverse event rates were 4.5% and 4.2% in the derivation and validation cohorts, respectively. The final risk adjustment model included age &lt;30 days, Procedural Risk in Congenital Cardiac Catheterization risk category, and hemodynamic vulnerability score (C statistic, 0.70; Hosmer-Lemeshow\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      value, 0.83; Brier score, 0.042).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>CHARM II (Congenital Heart Disease Adjustment for Risk Method II) risk adjustment methodology allows for equitable comparison of clinically meaningful adverse events among institutions and operators with varying patient populations and case mix complexity performing pediatric cardiac catheterization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.123.012834","type":"journal-article","created":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T05:00:28Z","timestamp":1705986028000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Catheterization for Congenital Heart Disease Adjustment for Risk Method II"],"prefix":"10.1161","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4440-2613","authenticated-orcid":true,"given":"Brian P.","family":"Quinn","sequence":"first","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren C.","family":"Gunnelson","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2410-7151","authenticated-orcid":true,"given":"Sarah G.","family":"Kotin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2597-3226","authenticated-orcid":true,"given":"Kimberlee","family":"Gauvreau","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9496-3462","authenticated-orcid":true,"given":"Mary J.","family":"Yeh","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babar","family":"Hasan","sequence":"additional","affiliation":[{"name":"Division of Cardio-Thoracic Sciences, Sindh Institute of Urology and Transplantation, Pakistan (B.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0769-7416","authenticated-orcid":true,"given":"John","family":"Lozier","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, UH Rainbow Babies and Children\u2019s Hospital, Cleveland, OH (J.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2726-7376","authenticated-orcid":true,"given":"Oliver M.","family":"Barry","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Columbia University Medical Center, New York Presbyterian\/Morgan Stanley Children\u2019s Hospital (O.M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1620-9709","authenticated-orcid":true,"given":"Shabana","family":"Shahanavaz","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Hospital\u2013Heart Institute and Department of Pediatrics, University of Cincinnati College of Medicine, OH (S.S., S.P.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8795-9526","authenticated-orcid":true,"given":"Sarosh P.","family":"Batlivala","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Hospital\u2013Heart Institute and Department of Pediatrics, University of Cincinnati College of Medicine, OH (S.S., S.P.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9632-4725","authenticated-orcid":true,"given":"Arash","family":"Salavitabar","sequence":"additional","affiliation":[{"name":"The Heart Center, Nationwide Children\u2019s Hospital, Columbus, OH (A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2643-0730","authenticated-orcid":true,"given":"Susan","family":"Foerster","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Children\u2019s Wisconsin, Milwaukee (S.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8508-9523","authenticated-orcid":true,"given":"Bryan","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Heart Institute, UPMC Children\u2019s Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh School of Medicine, PA (B.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1554-6554","authenticated-orcid":true,"given":"Abhay","family":"Divekar","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, UT Southwestern Medical Center, Children\u2019s Medical Center Dallas, TX (A.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2915-3724","authenticated-orcid":true,"given":"Ralf","family":"Holzer","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, University of California Davis, Sacramento (R.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5669-4070","authenticated-orcid":true,"given":"George T.","family":"Nicholson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt University Medical Center, Nashville, TN (G.T.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6023-1634","authenticated-orcid":true,"given":"Michael L.","family":"O\u2019Byrne","sequence":"additional","affiliation":[{"name":"Division of Cardiology, 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