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Background: The purpose of this study was to compare diagnostic performance of lung ultrasound in comparison to chest X-ray to detect pulmonary complication after cardiac surgery in children.Methods: A prospective observational study was conducted in tertiary center of Nepal. 141 consecutive paediatric patients aged less than 14 years scheduled for cardiac surgery were enrolled during the 6 months period. Ultrasound was done on the first post-operative day of cardiac surgery and compared to chest X-ray done on the same day to detect pleural effusion, consolidation, atelectasis and pneumothorax.Results: Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were calculated using standard formulas. lung ultrasonography had overall sensitivity of 60 %, specificity of 72.4%, positive predictive value of 31.9% and negative predictive value of 89.3% and diagnostic accuracy of 70.2% for diagnosing consolidation. Similarly, lung ultrasonography had overall sensitivity of 90%, specificity of 82.6%, positive predictive value of 46.1% and negative predictive value of 98% and diagnostic accuracy of 83.6 % for diagnosing pleural effusion. For atelectasis, ultrasonography had sensitivity of 50%, specificity of 76.9%, positive predictive value of 30.7% and negative predictive value of 88.2% and diagnostic accuracy of 72.3%. No pneumothoraxes were detected during our study period. Conclusions: Lung ultrasound is an alternative non-invasive technique which is able to diagnose pulmonary complications after cardiac surgery with acceptable diagnostic accuracy with no proven complications but with decreasing exposure to ionizing radiation and possibly cost.Keywords: Cardiac surgery; children; lung ultrasound; pulmonary complications

Objective: There is a growing consensus to reduce unnecessary testing among low-risk chest pain patients. The objective of this study was to evaluate the impact of implementing an education-based HEART score pathway in the emergency department on coronary computed tomography angiography (CCTA) utilization and yield. Methods: A retrospective before and after intervention study was conducted at a single site. Adult emergency department patients undergoing CCTA for suspected acute coronary syndrome were included. Primary outcomes were CCTA utilization and yield. Utilization was defined as the percentage of patients evaluated with CCTA and yield was calculated as the percentage of patients with a diagnosis of obstructive coronary artery disease, defined as ≥50% stenosis in any one coronary artery due to atherosclerosis. Results: 1540 patients undergoing CCTAs were included. CCTA utilization before and after were 2.2% [95% confidence interval (CI) 2.0–2.3] and 2.0% (95% CI 1.9–2.2), respectively; mean difference 0.1% (95% CI −0.1 to 0.3; P = 0.21). The mean age was 53 years (SD = 11) and females were 52%. Of 1477 patients included in CCTA yield analysis, patients diagnosed with obstructive coronary artery disease before and after were 15.0% (95% CI 12.6–17.7) and 16.2% (95% CI 13.6–19.1), respectively; mean difference 1.2% (95% CI −2.6 to 5.1; P = 0.53). Conclusions: There was no significant change in the CCTA utilization or yield after the implementation of an education-based HEART pathway in a large academic center. Our findings suggest adopting a more comprehensive approach for deploying such evidence-based protocols to increase institutional compliance.

INTRODUCTIONThe role of major cardiovascular risk factors in the development of coronary artery disease (CAD) is well established.1 The "Statement for Healthcare Professionals From the American Heart Association and the American College of Cardioloogy" ² states that the major and independent risk factors for CAD are cigarette smoking of any amount, elevated blood pressure, elevated serum total cholesterol and low density lipoprotein cholesterol (HDL-C), diabetes mellitus, and advancing age. The quantitative relationship between these risk factors and CAD risk has been elucidated by the Framingham Heart Study³ and other studies.The role of major cardiovascular risk factors in the development of CAD is markedly more common in male than in female.4-6 Literature shows that CAD incidence is 3 times higher in male compared with female. 7 Reasons for the sex difference in CAD risk are not fully understood. In the Prospective Follow Up Study of 14786 Middle-Aged Men and Women in Finland conducted by Pekka Jousilahti et. AI, 7 about 45% of the excess CAD risk of men was associated with the sex differences in cardiovascular risk factors. The difference in the total cholesterol and HDL, and smoking rate, contributed markedly to the excess CAD risk of men. Thus, in our study, we aim to investigate the major risk factors in MI patients admitted in CCU and to compare whether the association of those risk factors with CAD risk is similar in male and female.

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