Pediatric Appropriate Use Criteria Implementation Project: A Multicenter Outpatient Echocardiography Quality Initiative

Journal of the American College of Cardiology
Ritu SachdevaWyman W Lai

Abstract

Recently published appropriate use criteria (AUC) for initial pediatric outpatient transthoracic echocardiography (TTE) have not yet been evaluated for clinical applicability. This study sought to determine the appropriateness of TTE as currently performed in pediatric cardiology clinics, diagnostic yield of TTE for various AUC indications, and any gaps in the AUC document. Data were prospectively collected from patients undergoing initial outpatient TTE in 6 centers. TTE indications (appropriate [A], may be appropriate [M], or rarely appropriate [R]) and findings (normal, incidental, or abnormal) were recorded. Of the 2,655 studies ordered by 102 physicians, indications rated A, M, and R were found in 1,876 (71%), 316 (12%), and 319 studies (12%), respectively, and 144 studies (5%) were unclassifiable. Twenty-four of 113 indications (21%) were not used. Innocent murmur and syncope or palpitations with no other indications of cardiovascular disease, a benign family history, and normal electrocardiogram accounted for 75% of indications rated R. Pathologic murmur had the highest yield of abnormal findings (40%). Odds of an abnormal finding in an A or M TTE were 6 times that of R (95% confidence interval [CI]: [2.8 to 12.8]). Abno...Continue Reading

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Citations

Feb 28, 2017·The Journal of Pediatrics·Kirsten Rose-FelkerRitu Sachdeva
Apr 4, 2017·The Journal of Pediatrics·Tuan NguyenLeo Lopez
Mar 17, 2017·Congenital Heart Disease·Natalie M HoetingMatthew E Oster
Mar 6, 2017·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Ritu SachdevaWilliam L Border
Apr 25, 2018·Cardiology in the Young·Mark J CartoskiPhilip J Spevak
Nov 20, 2016·Congenital Heart Disease·Sean M LangR Thomas Collins
Jun 11, 2016·Congenital Heart Disease·Kirsten Rose-FelkerRitu Sachdeva
Oct 8, 2020·Cardiology in the Young·Saloni ShethCarolyn M Wilhelm
Oct 29, 2017·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Soultana KourtidouAmy H Schultz
Dec 6, 2017·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Kenan W D SternRitu Sachdeva

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