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Outpatient echocardiography in the evaluation of innocent murmurs in children: utilisation benchmarking

  • Patricio A. Frias (a1), Matthew Oster (a1), Patricia A. Daley (a2) and Jeffrey R. Boris (a2)



We sought to benchmark the utilisation of echocardiography in the outpatient evaluation of heart murmurs by evaluating two large paediatric cardiology centres.


Although criteria exist for appropriate use of echocardiography, there are no benchmarking data demonstrating its utilisation.


We performed a retrospective cohort study of outpatients aged between 0 and 18 years at the Sibley Heart Center Cardiology and the Children’s Hospital of Philadelphia Division of Cardiology, given a sole diagnosis of “innocent murmur” from 1 July, 2007 to 31 October, 2010. Using internal claims data, we compared the utilisation of echocardiography according to centre, patient age, and physician years of service.


Of 23,114 eligible patients (Sibley Heart Center Cardiology: 12,815, Children’s Hospital of Philadelphia Division of Cardiology: 10,299), 43.1% (Sibley Heart Center Cardiology: 45.2%, Children’s Hospital of Philadelphia Division of Cardiology: 40.4%; p<0.001) underwent echocardiography. There was wide variability in the utilisation of echocardiography by individual physicians at both centres (Sibley Heart Center Cardiology 18.3–85.5%, median 45.4%; Children’s Hospital of Philadelphia Division of Cardiology 13.9–81.8%, median 34.7%, p=0.45). Children in their first month of life represented the group with highest utilisation of echocardiography (62.3%), whereas children aged >1–5 years had the lowest utilisation (32.7%).


In two large paediatric cardiology practices, the overall utilisation of echocardiography by physicians with a sole diagnosis of innocent murmur was similar. There was significant and similar variability in utilisation by provider at both centres. Although these data serve as initial benchmarking, the variability in utilisation highlights the importance of appropriate use criteria.


Corresponding author

Correspondence to: J. R. Boris, MD, Division of Cardiology, Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States of America. Tel: +215 590 3180; Fax: +267 426 5324; E-mail:


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