Abstract：
BACKGROUND: Published guidelines for sports restriction for children with a bicuspid aortic valve remain controversial. We sought to describe practice variation and factors influencing sports restrictions in these children.
METHODS: This retrospective single-centre study included children (7-18 years old) with an isolated bicuspid aortic valve at baseline from 1 January, 2005 to 31 December, 2014. Sports restrictions, factors potentially influencing decision-making, and outcomes were collected. Descriptive statistics and multivariable mixed-effects logistic regression models were performed with providers and patients as random effects. Provider variation was estimated using intraclass correlation coefficients. Odds ratios, 95% confidence intervals, and p-values were reported from the models.
RESULTS: In 565 encounters (253 children; 34 providers), 41% recommended no sports restrictions, 40% recommended high-static and high-dynamic restrictions, and 19% had no documented recommendations. Based on published guidelines, 22% of children were inappropriately restricted while 30% were not appropriately restricted. The paediatric cardiology provider contributed to 37% of observed practice variation (p < 0.001). Sports restriction was associated with older age, males, greater ascending aorta z-score, and shorter follow-up interval. There were no aortic dissections or deaths and one cardiac intervention.
CONCLUSIONS: Physicians frequently fail to document sports restrictions for children with a bicuspid aortic valve, and documented recommendations often conflict with published guidelines. Despite this, no adverse outcomes occurred. Providers accounted for a significant proportion of the variation in sports restrictions. Further research to provide evidence-based guidelines may improve provider compliance with activity recommendations in this population.
METHODS: This retrospective single-centre study included children (7-18 years old) with an isolated bicuspid aortic valve at baseline from 1 January, 2005 to 31 December, 2014. Sports restrictions, factors potentially influencing decision-making, and outcomes were collected. Descriptive statistics and multivariable mixed-effects logistic regression models were performed with providers and patients as random effects. Provider variation was estimated using intraclass correlation coefficients. Odds ratios, 95% confidence intervals, and p-values were reported from the models.
RESULTS: In 565 encounters (253 children; 34 providers), 41% recommended no sports restrictions, 40% recommended high-static and high-dynamic restrictions, and 19% had no documented recommendations. Based on published guidelines, 22% of children were inappropriately restricted while 30% were not appropriately restricted. The paediatric cardiology provider contributed to 37% of observed practice variation (p < 0.001). Sports restriction was associated with older age, males, greater ascending aorta z-score, and shorter follow-up interval. There were no aortic dissections or deaths and one cardiac intervention.
CONCLUSIONS: Physicians frequently fail to document sports restrictions for children with a bicuspid aortic valve, and documented recommendations often conflict with published guidelines. Despite this, no adverse outcomes occurred. Providers accounted for a significant proportion of the variation in sports restrictions. Further research to provide evidence-based guidelines may improve provider compliance with activity recommendations in this population.
摘要：
背景：已发布的双叶主动脉瓣患儿运动限制指南仍存在争议。我们试图描述这些儿童的练习差异和影响运动限制的因素。
方法：这项回顾性单中心研究包括1月1日基线时出现孤立的二叶主动脉瓣的儿童（7-18岁），2005年12月31日，2014.体育限制,潜在影响决策的因素，并收集结果。对提供者和患者进行描述性统计和多变量混合效应逻辑回归模型作为随机效应。使用组内相关系数估计提供者的变异。赔率比,95%置信区间,和p值从模型中报告。
结果：在565次相遇中（253名儿童；34名提供者），41%的人建议没有运动限制，40%推荐高静态和高动态限制,19%没有记录的建议。根据已发布的指南，22％的儿童受到不适当的限制，而30％的儿童没有受到适当的限制。儿科心脏病学提供者占观察到的实践差异的37％（p<0.001）。运动限制与年龄有关，男性,升主动脉z评分较大，和较短的随访间隔。没有主动脉夹层或死亡和心脏介入。
结论：医生经常无法记录患有二叶主动脉瓣的儿童的运动限制，和成文的建议往往与公布的指南相冲突。尽管如此,无不良结局发生.提供商在体育限制的变化中占很大比例。提供循证指南的进一步研究可能会提高提供者对该人群活动建议的依从性。
方法：这项回顾性单中心研究包括1月1日基线时出现孤立的二叶主动脉瓣的儿童（7-18岁），2005年12月31日，2014.体育限制,潜在影响决策的因素，并收集结果。对提供者和患者进行描述性统计和多变量混合效应逻辑回归模型作为随机效应。使用组内相关系数估计提供者的变异。赔率比,95%置信区间,和p值从模型中报告。
结果：在565次相遇中（253名儿童；34名提供者），41%的人建议没有运动限制，40%推荐高静态和高动态限制,19%没有记录的建议。根据已发布的指南，22％的儿童受到不适当的限制，而30％的儿童没有受到适当的限制。儿科心脏病学提供者占观察到的实践差异的37％（p<0.001）。运动限制与年龄有关，男性,升主动脉z评分较大，和较短的随访间隔。没有主动脉夹层或死亡和心脏介入。
结论：医生经常无法记录患有二叶主动脉瓣的儿童的运动限制，和成文的建议往往与公布的指南相冲突。尽管如此,无不良结局发生.提供商在体育限制的变化中占很大比例。提供循证指南的进一步研究可能会提高提供者对该人群活动建议的依从性。
