title: Appropriateness criteria are an imprecise measure for repeat echocardiograms.
abstract: BACKGROUND
  Previous studies have reported that most transthoracic echocardiograms meet current ACC/ASE appropriateness criteria, but efficacy of appropriateness criteria for repeat echocardiograms has not been investigated. We sought to prospectively determine whether current appropriateness criteria accurately assess the need for repeat echocardiograms in a consecutive series of inpatients in a tertiary care community teaching hospital.
  
  
  RESULTS
  Appropriateness criteria were assessed for consecutive echocardiograms ordered over 30 days. Ordering clinician specialty and level of training were recorded. For repeat echocardiograms, change in clinical status between first and second echocardiogram and any change in echocardiographic findings were documented. Out of 574 echocardiograms analyzed, 143 repeat studies were performed in 104 patients. Level of appropriateness for first time studies was estimated at 84.6% and for repeat studies at 73.4% (x(2) = 7.71, P = 0.005). Of those patients receiving at least 1 repeat echocardiogram 42 patients (40%) experienced no detectable change in clinical status or other reason that would justify a repeat study. New echocardiographic findings were found in slightly more than half (52%) of patients receiving repeat studies.
  
  
  CONCLUSIONS
  Inappropriate repeat echocardiograms are ordered more frequently than first time studies. A significant proportion of repeat echocardiograms do not appear to be justified, and often yield no new echocardiographic findings. Our data suggest that current appropriateness criteria might benefit from further revision with particular regard to justification for repeat studies.
authors.affiliation: Division of Cardiology, Hartford Hospital, Hartford, Connecticut Department of Psychology, Connecticut College, New London, Connecticut.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Ghatak
authors.forename: Raja
authors.initials: R
authors.lastname: Pullatt
authors.forename: Stuart
authors.initials: S
authors.lastname: Vyse
authors.forename: David I
authors.initials: DI
authors.lastname: Silverman
mesh_terms: D003237:Connecticut / Q000453:epidemiology; D004452:Echocardiography / Q000592:standards* / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity