Risk Stratification in Pediatric Cardiac Catheterization Using the CRISP Score: A Cross-Sectional Study in Indonesia

Fajrin Dwi Syaputra; Andi Adil; Hisbullah; Andi Salahuddin; Alamsyah Ambo  Ala Husain; Ari Santri Palinrungi

doi:10.18502/aacc.v12i2.20946

Fajrin Dwi Syaputra Department of Anesthesiology, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Andi Adil Department of Anesthesiology, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Hisbullah Department of Anesthesiology, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Andi Salahuddin Department of Anesthesiology, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Alamsyah Ambo Ala Husain Department of Anesthesiology, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Ari Santri Palinrungi Department of Anesthesiology, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.

DOI: https://doi.org/10.18502/aacc.v12i2.20946

Keywords: Congenital heart disease; CRISP score; Pediatric cardiac catheterization; Serious adverse events; Risk prediction

Abstract

Background: Cardiac catheterization is an essential procedure in managing pediatric congenital heart disease, providing a less invasive alternative to thoracotomy. However, adverse events remain a concern, especially in high-risk patients. The CRISP (Cardiac Risk in Pediatric) score, developed by the Congenital Cardiac Intervention Study Consortium (CCISC), predicts serious adverse events (SAEs) in pediatric cardiac catheterization. Despite its reliability, CRISP has not been implemented in Indonesia. This study evaluates its predictive ability at Dr. Wahidin Sudirohusodo Hospital, Makassar.

Methods: A prospective cross-sectional study was conducted from November 2024 to January 2025. Pediatric patients (<18 years) undergoing elective cardiac catheterization were assigned CRISP scores pre-procedure, and adverse events were recorded. The relationship between CRISP categories and SAE incidence was analyzed.

Results: Among 70 patients, the majority of patients were categorized as CRISP I (67.1%), followed by CRISP II (21.4%), CRISP III (5.7%), and CRISP IV (5.7%), with no CRISP V cases. There were 6 cases (8.6%) of serious adverse events identified, consisting of 4 cases (5.71%) of cardiac arrest and 2 cases (2.89%) of bleeding. A significant correlation was found between higher CRISP risk categories and SAE incidence (p < 0.001). SAEs occurred exclusively in CRISP III (50% incidence) and CRISP IV (100% incidence) patients.

Conclusion: The CRISP score effectively stratifies risk in pediatric cardiac catheterization. Higher CRISP categories correlate with increased SAE incidence, supporting its predictive validity. Routine CRISP implementation could enhance pre-procedural planning, risk mitigation, and patient safety in Indonesia. Further studies with larger sample sizes are recommended.