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Appropriate Use Criteria for paediatric echocardiography in an outpatient practice: a validation study

Published online by Cambridge University Press:  25 April 2018

Mark J. Cartoski ,
Meghan Kiley  and
Philip J. Spevak
Mark J. Cartoski*
Affiliation:
Department of Paediatrics, Johns Hopkins University, Baltimore, MD, USA Division of Paediatric Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA
Meghan Kiley
Affiliation:
Department of Paediatrics, Johns Hopkins University, Baltimore, MD, USA
Philip J. Spevak
Affiliation:
Department of Paediatrics, Johns Hopkins University, Baltimore, MD, USA Division of Paediatric Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA
*
Author for correspondence: M. J. Cartoski, Division of Paediatric Cardiology, Bloomberg Children’s Center, 1800 Orleans Street, Baltimore, MD 21287, USA. Tel: 410 955 5517; Fax: 410 955 0897; E-mail: mcartos1@jhmi.edu
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Abstract

Background

Although transthoracic echocardiography is the dominant imaging modality in CHD, optimal utilisation is unclear. We assessed whether adherence to the paediatric Appropriate Use Criteria for outpatient transthoracic echocardiography could reduce inappropriate use without missing significant cardiac disease.

Methods

Using the Appropriate Use Criteria, we determined the indication and appropriateness rating for each initial echocardiogram performed at our institution during calendar year 2014 (N=1383). Chart review documented ordering provider training, patient demographics, and study result, classified as normal, abnormal, or abnormal motivating treatment within a 2-year follow-up period. We tested whether provider training level or patient age correlated with echocardiographic findings or appropriateness rating.

Results

We found that 83.9% of echocardiograms were normal and that 66.7% had an appropriate indication. Nearly all abnormal results and all results motivating treatment were in appropriate studies, giving an odds ratio of 2.73 for an abnormal result if an appropriate indication was present (95% confidence interval 1.92–3.89, p<0.001). None of the remaining initial abnormal results with less than appropriate indications became significant, resulting in treatment over 2 years. Results suggest a potential reduction in imaging volume of as much as 33% with application of the criteria. Cardiologists ordered nearly all studies resulting in treatment but also more echocardiograms with less appropriate indications. Most examinations were in older patients; however, most abnormal results were in patients younger than 1 year.

Conclusions

The Appropriate Use Criteria can be used to safely reduce echocardiography volume while still detecting significant heart disease.

Keywords

Echocardiographypaediatricappropriate usequality improvement
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 6 , June 2018 , pp. 862 - 867
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Copyright
© Cambridge University Press 2018 

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