Prospective evaluation of the clinical application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria for transthoracic echocardiography.
We sought to prospectively evaluate the clinical application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria (AC) for transthoracic echocardiography in a single-center university hospital. Indications for transthoracic echocardiograms (TTE) were prospectively determined for consecutive studies by 2 reviewers and categorized, according to the AC for TTE, as appropriate (A) or inappropriate (I). The overall level of agreement in characterizing appropriateness between reviewers was high (kappa = 0.83). Among the 1,553 studies for which a primary indication was determined, 89% were covered in the AC for TTE. Of these studies, 89% were A, and 11% were I. New important TTE abnormalities were more common on A compared with I studies (40% vs. 17%, p < 0.001), and noncardiac specialists more frequently ordered I studies (13% vs. 9%, p = 0.04). In conclusion, the AC for TTE encompasses the majority of clinical indications for TTE and appears to reasonably stratify TTE ordering. However, revisions will be needed to fully capture and stratify appropriate clinical practice.
Ward
R Parker
RP
Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA. pward@medicine.bsd.uchicago.edu
Mansour
Ibrahim N
IN
Lemieux
Nicole
N
Gera
Nitin
N
Mehta
Rupa
R
Lang
Roberto M
RM
D000328:Adult; D000368:Aged; D004452:Echocardiography / Q000592:standards / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006785:Hospitals, University / Q000592:standards; D006801:Humans; D007087:Illinois; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards; D012955:Societies, Medical; D019564:Unnecessary Procedures; D014600:Utilization Review