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Appropriate use of echocardiography for palpitations in paediatric cardiology clinics

Published online by Cambridge University Press:  07 October 2020

Saloni Sheth Open the ORCID record for Saloni Sheth [Opens in a new window] ,
Munes Fares ,
Sandra Kikano ,
Christopher Snyder ,
Andrew Dodgen  and
Carolyn M. Wilhelm
Saloni Sheth*
Affiliation:
Department of Paediatrics, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
Munes Fares
Affiliation:
Department of Paediatric Cardiology, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
Sandra Kikano
Affiliation:
Department of Paediatrics, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
Christopher Snyder
Affiliation:
Department of Paediatric Cardiology, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
Andrew Dodgen
Affiliation:
Department of Paediatric Cardiology, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA Department of Paediatric Cardiology, Children’s Healthcare of Atlanta, Columbus, GA, USA
Carolyn M. Wilhelm
Affiliation:
Department of Paediatric Cardiology, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
*
Author for correspondence: Saloni Sheth, MD, 11100 Euclid Ave, RB&C Room 838, Mail stop 6002, Cleveland, OH44106, USA. Tel: +1 216 844 1000; Fax: +216-844-7166. E-mail: Saloni.Sheth@uhhospitals.org
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Abstract

Objectives:

Identify diagnostic yield and frequency of echocardiograms for palpitation-related indications at outpatient paediatric cardiology clinics in relation to the 2014 ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE appropriate use criteria for Initial Transthoracic Echocardiography in Outpatient Paediatric Cardiology.

Study design:

A single-centre, retrospective study of children presenting for evaluation of a chief complaint of palpitations to outpatient paediatric cardiology clinics from 2015 to 2017. Palpitations were defined as an unpleasant sensation of rapid, irregular, and/or forceful beating of the heart. Indications for echocardiogram in patients were retrospectively classified based on the appropriate use criteria as “appropriate,” “may be appropriate,” or “rarely appropriate.” The incidence of abnormal and incidental echocardiographic findings for each category was determined.

Results:

A total of 286 patients presented with palpitations, with 128 (52% female) meeting inclusion criteria. Exclusion criteria included patients with additional cardiac complaints, prior echocardiogram, or history of congenital heart disease. Echocardiograms were performed on 36 (28%) patients. The appropriate use criteria were retrospectively applied, and indications for their performance were classified as “appropriate” (n = 4), “may be appropriate” (n = 17), or “rarely appropriate” (n = 15). Minor echocardiographic abnormalities were present in 22% (n = 8) of echocardiograms obtained for all appropriate use criteria classifications. No moderate or severe echocardiographic abnormalities were found. Incidental findings were noted in eight echocardiograms.

Conclusion:

Echocardiography in the evaluation of “rarely appropriate” and “may be appropriate” palpitation-related indications is of low diagnostic yield.

Keywords

Paediatric appropriate use criteriapalpitationsechocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 1 , January 2021 , pp. 60 - 62
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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