# The Impact of Risk Score Use in Predicting Serious Adverse Events During Cardiac Catheterization Procedures in Pediatric Patients

## TL;DR

This study shows that the CRISP score effectively predicts serious complications during heart procedures in children.

## Contribution

The study demonstrates the predictive value of CRISP score for adverse events in pediatric cardiac catheterization.

## Key findings

- CRISP score categories correlate with increasing rates of serious adverse events.
- The area under the curve for CRISP score predicting SAEs was 0.84, indicating strong predictive ability.
- Higher CRISP scores were associated with a higher incidence of arrhythmia-related complications.

## Abstract

Background: Cardiac catheterization may be required in the management of congenital heart diseases. The use of risk scoring or grading systems in these procedures can assist in planning the intervention and predicting potential complications. This study aimed to evaluate the use of risk scores in grading cardiac catheterization procedures in pediatric patients and to investigate their predictive value for serious adverse events (SAEs). Material and Methods: A total of 700 pediatric patients (350 male; median age 1 year [IQR 6 months–2 years]) who underwent cardiac catheterization in our catheterization laboratory between 1 January 2023 and 1 January 2025 were retrospectively analyzed. Demographic and clinical data of the patients, including procedure duration, anesthesia management, Catheterization Risk in Pediatrics Score (CRISP), and serious adverse events related to the procedure, were recorded. The results were analyzed statistically. Results: In total, 50% of the patients were male (n = 350), and 58% (n = 406) had single-ventricle physiology. Interventional procedures were performed in 72% of the cases. The median CRISP score was 8 (IQR 6–10). SAEs occurred in 7.7% of the patients (n = 54), most of which were arrhythmia-related. The incidence of SAEs was analyzed according to CRISP score categories. The rates of SAEs in patients with CRISP Categories 1 through 5 were 2.9%, 4.3%, 11%, 17.3%, and 41%, respectively. As the CRISP score and category increased, the incidence of SAEs also increased [area under the curve of 0.84 (95% confidence interval, 0.76–0.92; p < 0.05)]. Conclusions: CRISP may serve as an effective benchmarking and risk classification tool in pediatric cardiac catheterization procedures and can predict SAE occurrence. Therefore, it may have a positive impact on patient care by assisting in the planning of pre- and post-catheterization care.