title: Application of appropriateness criteria in outpatient transthoracic echocardiography.
abstract: 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.
authors.affiliation: Department of Medicine, Cardiovascular Division, Echocardiography Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA. james.kirkpatrick@uphs.upenn.edu
authors.forename: James N
authors.initials: JN
authors.lastname: Kirkpatrick
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ky
authors.forename: Hind W
authors.initials: HW
authors.lastname: Rahmouni
authors.forename: Julio A
authors.initials: JA
authors.lastname: Chirinos
authors.forename: Steven A
authors.initials: SA
authors.lastname: Farmer
authors.forename: Anjali V
authors.initials: AV
authors.lastname: Fields
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ogbara
authors.forename: Karen M
authors.initials: KM
authors.lastname: Eberman
authors.forename: Victor A
authors.initials: VA
authors.lastname: Ferrari
authors.forename: Frank E
authors.initials: FE
authors.lastname: Silvestry
authors.forename: Martin G
authors.initials: MG
authors.lastname: Keane
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Opotowsky
authors.forename: Martin St John
authors.initials: MS
authors.lastname: Sutton
authors.forename: Susan E
authors.initials: SE
authors.lastname: Wiegers
mesh_terms: 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