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
References
Jan 10, 2009·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·James N KirkpatrickSusan E Wiegers
Apr 10, 2009·JACC. Cardiovascular Imaging·R Parker WardRoberto M Lang
Sep 22, 2009·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·R Parker WardUNKNOWN American Society of Echocardiography
Jan 19, 2010·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Niti R AggarwalUNKNOWN American College of Cardiology Foundation
Jan 26, 2011·Circulation·Raymond J GibbonsTodd Miller
Apr 28, 2012·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·Gabriel P SilvermanDavid I Silverman
Jun 26, 2012·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Simone A BaileyAndrew M Keller
Aug 18, 2012·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·R Sacha BhatiaRory B Weiner
Sep 25, 2012·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Ibrahim N MansourR Parker Ward
Apr 16, 2013·JACC. Cardiovascular Imaging·R Sacha BhatiaRory B Weiner
Jul 24, 2013·JAMA Internal Medicine·Susan A MatuleviciusSharon C Reimold
Jan 23, 2014·Echocardiography·Rajan Sacha BhatiaRory B Weiner
Feb 28, 2015·Journal of the American College of Cardiology·Ricardo FonsecaThomas H Marwick
Citations
Feb 28, 2017·The Journal of Pediatrics·Kirsten Rose-FelkerRitu Sachdeva
Apr 4, 2017·The Journal of Pediatrics·Tuan NguyenLeo Lopez
Feb 23, 2017·Congenital Heart Disease·Ritu SachdevaWyman W Lai
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
Feb 9, 2017·Echocardiography·Heather M PhelpsRitu Sachdeva
Apr 25, 2018·Cardiology in the Young·Mark J CartoskiPhilip J Spevak
Oct 9, 2018·Congenital Heart Disease·Shae AndersonRitu Sachdeva
Oct 24, 2018·Congenital Heart Disease·Soham DasguptaRitu Sachdeva
Nov 20, 2016·Congenital Heart Disease·Sean M LangR Thomas Collins
Jun 11, 2016·Congenital Heart Disease·Kirsten Rose-FelkerRitu Sachdeva
Jun 10, 2020·Echocardiography·Kenan W D SternRitu Sachdeva
Jan 16, 2020·Pediatric Cardiology·Markus S RennoDavid A Parra
Aug 9, 2020·Pediatric Quality & Safety·Erik L FrandsenBrian D Soriano
Jul 9, 2017·Pediatric Cardiology·Raya SafaDaisuke Kobayashi
Oct 8, 2020·Cardiology in the Young·Saloni ShethCarolyn M Wilhelm
Nov 3, 2020·Pediatric Quality & Safety·Soham DasguptaRitu Sachdeva
Jan 11, 2020·Journal of the American College of Cardiology·Ritu SachdevaAli N Zaidi
Aug 17, 2021·Congenital Anomalies·Esma Keleş AlpAhmet Midhat Elmacı
Aug 25, 2021·Clinical Pediatrics·Tracey M ThompsonDavid W Jantzen
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