Coding 299 fetal hearts scans using one single item from ACC-CHD and IPCCC lists: Limits, results, and comparison of discordances related to professional experience

Abstract

The international nomenclature of Congenital Heart Diseases (CHD) remains challenging. Classifications have been proposed such as the International Pediatric and Congenital Cardiac Code (IPCCC) and the ACC-CHD (Anatomic and Clinical Classification). We retrospectively included all consecutive fetal echocardiograms (1 cardiologist) over 6 years. Reports were independently coded with 1 single code (the most precise) by 3 pediatric cardiologists with increasing experience (junior [J], senior I [SI] and II [SII]). Discordances between doctors were compared to a gold standard code secondary fixed by SI and SII, with focus on coding difficulties and effects of professional experience using IPCCC and ACC-CHD. Among 299 scans, 7 were excluded (doubts). Coding was always possible with IPCCCC, but not achieved in 112 cases with ACC-CHD. One hundred and eighty hearts were selected. Using either IPCCC or ACC-CHD, coding with 1 item was difficult for SI and SII in 15% of cases (ACC-CHD categories 6, 9, 8). IPCCC was too exhaustive for its simple use leading to discordance. ACC-CHD was also difficult to use (learning curve, use of 1 code, complex CHD). Coding discordance using ACC-CHD main categories was higher for junior compared to seniors (J-SI, P = 0.04; J-SII, P = 0.02), without difference between seniors. Compared to the gold standard for ACC-CHD (main, sub) categories, junior concordance was lower (73.3%, 71.1%) than SI (90%, 83.3%, P < 0.005) and SII (88.3%, 87.2%, P < 0.0001). Senior concordance was stronger (75%) with ACC-CHD sub categories compared to IPCCC (65%, P = 0.028). IPCCC and ACC-CHD remain difficult for their use in clinical practice. Many functional abnormalities are not listed in the ACC-CHD but could be updated with a few more sub groups. The use of 1 code appears restrictive to well classify some complex CHD and limits our study. However, we believe that some ACC-CHD categories allow simplification with prognosis issues for further studies.