Application of appropriateness criteria in outpatient transthoracic echocardiography.
BACKGROUND
Appropriateness criteria were applied to outpatient transthoracic echocardiographic (TTE) studies.


METHODS
Indications were rated as appropriate, inappropriate, or unclassifiable, considering provider-stated indications, previous TTE studies, symptom changes, and patient-stated indications. Clinically important new or unexpected findings were recorded.


RESULTS
Of 368 TTE studies, 206 (56%) were appropriate, 31 (8%) were inappropriate, and 131 (35%) were unclassifiable. Appropriateness was not correlated with patient or provider demographics. In 288 cases with prior TTE studies, there were 92 (32%) important new findings and 63 (22%) unexpected findings, of which 20% were from inappropriately ordered and 31% from unclassifiable TTE studies. Appropriateness was not associated with new (odds ratio, 1.23; 95% confidence interval, 0.48-3.18) or unexpected (odds ratio, 1.15; 95% confidence interval, 0.38-3.52) findings. Provider type and level of training were not correlated with new or unexpected findings.


CONCLUSIONS
Many indications for TTE studies were unclassifiable. A high percentage of inappropriately ordered TTE studies yielded important information. Care must be taken in judging the value of TTE studies solely on the basis of appropriateness criteria.
Kirkpatrick
James N
JN
Department of Medicine, Cardiovascular Division, Echocardiography Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA. james.kirkpatrick@uphs.upenn.edu
Ky
Bonnie
B
Rahmouni
Hind W
HW
Chirinos
Julio A
JA
Farmer
Steven A
SA
Fields
Anjali V
AV
Ogbara
Jeffrey
J
Eberman
Karen M
KM
Ferrari
Victor A
VA
Silvestry
Frank E
FE
Keane
Martin G
MG
Opotowsky
Alexander R
AR
Sutton
Martin St John
MS
Wiegers
Susan E
SE
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014600:Utilization Review