{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T19:55:21Z","timestamp":1793044521274,"version":"4.5.0"},"reference-count":40,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100012021","name":"Iran University of Medical Sciences","doi-asserted-by":"publisher","award":["1402-2-113-26934"],"award-info":[{"award-number":["1402-2-113-26934"]}],"id":[{"id":"10.13039\/100012021","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Med Res"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Children with congenital heart disease are highly vulnerable to drug-related adverse effects due to the use of complex polypharmacy. This study aimed to develop and retrospectively evaluate a hybrid clinical decision support system for predicting drug-related adverse effects in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This two-phase study combined machine-learning techniques and expert clinical rules. Phase 1 included a retrospective analysis of 4651 pediatric congenital heart disease reports from the Food and Drug Administration Adverse Event Reporting System to train and compare five machine-learning models. The best-performing model, Random Forest, was selected. In Phase 2, a hybrid clinical decision support system integrating the Random Forest model with an expert-validated rule-based engine was developed and retrospectively evaluated using 330 inpatient records of pediatric patients with congenital heart disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The Random Forest model achieved a mean area under the receiver operating characteristic curve of 0.902. During clinical validation, the hybrid clinical decision support system demonstrated a mean accuracy of 0.85 across 11 common drug\u2013adverse effect pairs, outperforming standalone machine-learning\u2013 and rule-based approaches. This study demonstrated the feasibility and clinical fidelity of using a hybrid clinical decision support system for predicting drug-related adverse effects in pediatric patients with congenital heart disease, supporting safer and more personalized pharmacotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrated the feasibility and clinical fidelity of using a hybrid clinical decision support system for predicting drug-related adverse effects in pediatric patients with congenital heart disease, supporting safer and more personalized pharmacotherapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03000605261472034","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T15:48:16Z","timestamp":1785599296000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["A clinical decision support system for predicting drug-related adverse effects in pediatric patients with congenital heart disease: Development and retrospective evaluation"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5156-2853","authenticated-orcid":false,"given":"Esmaeel","family":"Toni","sequence":"first","affiliation":[{"name":"Iran University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3974-3648","authenticated-orcid":false,"given":"Haleh","family":"Ayatollahi","sequence":"additional","affiliation":[{"name":"Health Management Research Institute, Iran University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7885-117X","authenticated-orcid":false,"given":"Reza","family":"Abbaszadeh","sequence":"additional","affiliation":[{"name":"Heart Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7804-4084","authenticated-orcid":false,"given":"Alireza","family":"Fotuhi Siahpirani","sequence":"additional","affiliation":[{"name":"University of Tehran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,1]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2025.1522644"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz009"},{"key":"e_1_3_3_4_2","first-page":"7931","article-title":"Spatial distribution and birth prevalence of congenital heart disease in Iran: a systematic review and hierarchical Bayesian meta-analysis","volume":"13","author":"Farhadi Hassankiadeh R","year":"2024","unstructured":"Farhadi Hassankiadeh R, Dobson A, Rahimi S, et al. Spatial distribution and birth prevalence of congenital heart disease in Iran: a systematic review and hierarchical Bayesian meta-analysis. Int J Health Policy Manag 2024; 13: 7931.","journal-title":"Int J Health Policy Manag"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(23)00053-6"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcdd9070201"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.70835"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/jcph.1834"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.828010"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40272-024-00644-8"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.21037\/tp.2018.04.03"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.15150"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11704-024-31063-0"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.3390\/ph17060795"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0167683"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocz135"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2023.104428"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocaa154"},{"key":"e_1_3_3_19_2","article-title":"Risk factors associated with drug-related side effects in children: a scoping review","volume":"11","author":"Toni E","year":"2024","unstructured":"Toni E, Ayatollahi H, Abbaszadeh R, et al. Risk factors associated with drug-related side effects in children: a scoping review. Glob Pediatr Health 2024; 11:2333794X241273171.","journal-title":"Glob Pediatr Health"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"e_1_3_3_21_2","article-title":"Similarity-based method with multiple-feature sampling for predicting drug side effects","volume":"2022","author":"Wu Z","year":"2022","unstructured":"Wu Z, Chen L. Similarity-based method with multiple-feature sampling for predicting drug side effects. Comput Math Methods Med 2022; 2022: 9547317.","journal-title":"Comput Math Methods Med"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1021\/acs.molpharmaceut.9b01248"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1109\/BIBM.2013.6732532"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mbs.2018.09.010"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1117\/12.2675459"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2023.1151560"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076241286434"},{"key":"e_1_3_3_28_2","article-title":"Developing a complex rule-based clinical decision support system for detection of acute kidney injury after pediatric cardiac surgery","volume":"72","author":"Wachenbrunner J","year":"2024","unstructured":"Wachenbrunner J, Mast M, B\u00f6hnke J, et al. Developing a complex rule-based clinical decision support system for detection of acute kidney injury after pediatric cardiac surgery. Thorac Cardiovasc Surg 2024; 72: S69\u2013S96.","journal-title":"Thorac Cardiovasc Surg"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.4266\/acc.2023.01424"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40264-021-01123-6"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-021-01366-4"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2025.109749"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12961-025-01332-w"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2023-002432"},{"key":"e_1_3_3_35_2","article-title":"Addressing drug-related side effects in children with congenital heart disease: a policy brief","volume":"11","author":"Toni E","year":"2024","unstructured":"Toni E, Ayatollahi H. Addressing drug-related side effects in children with congenital heart disease: a policy brief. Glob Pediatr Health 2024; 11: 2333794X241291398.","journal-title":"Glob Pediatr Health"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2024.1357972"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1136\/ejhpharm-2017-001300"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2022.1016522"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1177\/00469580251335805"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.EJ20-0307"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11164715"}],"container-title":["Journal of International Medical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03000605261472034","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/03000605261472034","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03000605261472034","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:18:01Z","timestamp":1785849481000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/03000605261472034"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":40,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1177\/03000605261472034"],"URL":"https:\/\/doi.org\/10.1177\/03000605261472034","relation":{},"ISSN":["0300-0605","1473-2300"],"issn-type":[{"value":"0300-0605","type":"print"},{"value":"1473-2300","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"article-number":"03000605261472034"}}