Annex A > Chapter 19 - Statistics Relating to the Clinical Performance of Paediatric Cardiac Surgical Services in Bristol Compared with Other Specialist Centres during the Period 1984 to 1995 > Section four: the evidence of the Inquiry's Experts relating to post-operative morbidity > The Experts' overall conclusions
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The Experts' overall conclusions
126 In their Overview Report to the Inquiry, Dr David Spiegelhalter, Professor Stephen Evans, Dr Paul Aylin and Professor Gordon Murray reviewed the evidence on post-operative morbidity and concluded:
`In response to the findings of Aylin (1999, INQ 0013 0028) of an apparently higher rate of neurological complications in Bristol, Evans (2000, INQ 0029) examined evidence on complication rates in local data sources. The Surgeons' Logs (SL) did not, predictably, contain good information on longer-term outcomes, while both in the coded clinical records (CCR) and PAS the recorded neurological complication rates among survivors of open surgery was very low (1.9% and less than 1% respectively). There was poor agreement between sources and Evans (2000, INQ 0029 0016) concluded that there was under-reporting in all centres, with Bristol possibly being slightly more accurate in its reporting. The Clinical Case Note Review (CCNR) did look in detail at the possibility of disability in those who had not died at 30 days, but with only 40 cases, even though they were preferentially sampled from high risk groups, the number with any disability was very small (4, all "moderate"disability). It is therefore not possible to draw confident conclusions on the true morbidity rate or make comparisons with other centres. ...
`The routine data sources available form an inappropriate basis for any firm conclusions concerning morbidity rates in Bristol.' [184]
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Footnotes
[184] INQ 0045 0024; `Overview of statistical evidence presented to the Bristol Royal Infirmary Inquiry concerning the nature and outcomes of paediatric cardiac surgical services at Bristol relative to other specialist centres from 1984 to 1995', September 2000, Dr Spiegelhalter et al.