Abstract
Transthoracic echocardiography (TTE) is a non-invasive diagnostic modality for children with suspected heart disease. The American College of Cardiology published Appropriate Use Criteria (AUC) for an initial outpatient pediatric TTE in 2014 to promote effective care and improve resource utilization. The objective was to determine the appropriateness of TTE per the published AUC in a single academic pediatric cardiology clinic as a baseline performance quality measure. The echocardiography database was used to identify initial outpatient TTE in children during January–March 2014. TTE indications (appropriate [A], may be appropriate [M], or rarely appropriate [R]) and findings (normal, incidental, or abnormal) were recorded. The effect of AUC and age groups on yield of abnormal TTE findings was analyzed. Of the 2166 screened studies, our study cohort consisted of 247 TTEs. Indications rated A, M, and R were found in 129, 27, and 90, respectively, and 1 was unclassifiable. Majority of TTE (n = 183) were normal, although incidental findings were noted in 32 and abnormal findings in 32 cases. Abnormal findings were noted in 26/129 of A, 2/27 of M, and 4/90 of R. Indications rated A were significantly associated with yield of abnormal TTE findings, adjusted by age group. Infants and adolescents were more likely to have abnormal TTE findings compared to young children. Recently published AUC were validated for initial TTE in the outpatient pediatric cardiology clinic. Appropriateness rated by AUC was highly associated with yield of abnormal TTE findings and worked best in infants and adolescent.
Similar content being viewed by others
References
Campbell RM, Douglas PS, Eidem BW, Lai WW, Lopez L, Sachdeva R (2014) ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE 2014 appropriate use criteria for initial transthoracic echocardiography in outpatient pediatric cardiology: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Academy of Pediatrics, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Coll Cardiol 64:2039–2060
Sachdeva R, Allen J, Benavidez OJ, Campbell RM, Douglas PS, Eidem BW, Gold L, Kelleman MS, Lopez L, McCracken CE, Stern KW, Weiner RB, Welch E, Lai WW (2015) Pediatric appropriate use criteria implementation project: a multicenter outpatient echocardiography quality initiative. J Am Coll Cardiol 66:1132–1140
Rose-Felker K, Kelleman MS, Campbell RM, Oster ME, Sachdeva R (2016) Appropriate use and clinical impact of echocardiographic “Evaluation of Murmur” in pediatric patients. Congenit Heart Dis 11(6):721–726
Sachdeva R, Douglas PS, Kelleman MS, McCracken CE, Lopez L, Stern KW, Eidem BW, Benavidez OJ, Weiner RB, Welch E, Campbell RM, Lai WW (2016) Effect of release of the first pediatric appropriate use criteria on transthoracic echocardiogram ordering practice. Am J Cardiol 118:1545–1551
Phelps HM, Kelleman MS, McCracken CE, Benavidez OJ, Campbell RM, Douglas PS, Eidem BW, Lai WW, Lopez L, Stern KW, Welch E, Sachdeva R (2017) Application of pediatric appropriate use criteria for initial outpatient evaluation of syncope. Echocardiography. doi:10.1111/echo.13475
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
No conflict of interest, grants, or other financial support.
Ethical Approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Rights and permissions
About this article
Cite this article
Safa, R., Aggarwal, S., Misra, A. et al. Application of Appropriate Use Criteria for Initial Transthoracic Echocardiography in an Academic Outpatient Pediatric Cardiology Program. Pediatr Cardiol 38, 1282–1287 (2017). https://doi.org/10.1007/s00246-017-1659-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-017-1659-9