Application of the appropriateness criteria for echocardiography in an academic medical center.
BACKGROUND
The authors examined the feasibility of application of the American College of Cardiology Foundation's appropriateness criteria for transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) at a large tertiary care practice.


METHODS
Indications for consecutive TTE and TEE were determined by chart review and classified according to the guidelines as appropriate, inappropriate, or uncertain or, for situations not addressed in the document, nonclassifiable.


RESULTS
Of the 529 studies reviewed, 469 were appropriate, 23 inappropriate, 1 uncertain, and 36 nonclassifiable. Inappropriate and nonclassifiable studies were more commonly TTE than TEE (P<.001). Inappropriate studies were more common in outpatients than inpatients (P<.001). Nonclassifiable cases included assessment after radiofrequency ablation (33.3%) and preoperative evaluation (8.3%). Disagreement between observers in selection of the criterion was present in 30.8%.


CONCLUSIONS
Although the study was conducted retrospectively, only 4.7% of classifiable studies were inappropriate. The reproducibility of classification was moderate, and 6.8% of studies were not classifiable. Areas for improvement of the criteria were identified.
Aggarwal
Niti R
NR
Department of Medicine, Mayo Clinic Foundation, Rochester, Minnesota 55905, USA.
Wuthiwaropas
Punsak
P
Karon
Barry L
BL
Miller
Fletcher A
FA
Pellikka
Patricia A
PA
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D004452:Echocardiography / Q000592:standards* / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014600:Utilization Review