title: The utility of prescreening transesophageal echocardiograms: a prospective study.
abstract: BACKGROUND
  Recent emphasis on the judicious use of imaging prompted the publication of the 2007 ACC/ASE Appropriateness Use Criteria (AUC) for Echocardiography. However, the intersection of the AUC with the safety and clinical use of transesophageal echocardiography (TEE) is not well established.
  
  
  METHODS
  We reviewed 490 consecutive orders for TEEs for appropriateness, significant findings, and reasons for cancellation.
  
  
  RESULTS
  We found that 79% (389/490) of ordered studies were performed and 21% (101/490) were not. The number of TEEs cancelled for safety reasons (n = 29) was similar to that cancelled for inappropriateness (n = 36). Only 2% (6/389) of those performed were inappropriate vs. 16% of those that were cancelled. New or unsuspected findings were obtained in half of all performed TEEs; the majority of which were ordered to detect cardiac source of embolism (CSE).
  
  
  CONCLUSIONS
  The AUC should specifically consider the utility of clinician-based prescreening of TEEs to encourage appropriate use and safety. Furthermore, given the incremental value of TEE over transthoracic echocardiography in detection of CSE, in some cases, TEE may be considered an appropriate initial test for this indication.
authors.affiliation: Department of Medicine, Cardiovascular Division, Echocardiography Laboratory University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ogbara
authors.forename: Sachin
authors.initials: S
authors.lastname: Logani
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ky
authors.forename: Julio A
authors.initials: JA
authors.lastname: Chirinos
authors.forename: Frank E
authors.initials: FE
authors.lastname: Silvestry
authors.forename: Karen
authors.initials: K
authors.lastname: Eberman
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Moss
authors.forename: Victor A
authors.initials: VA
authors.lastname: Ferrari
authors.forename: Martin G
authors.initials: MG
authors.lastname: Keane
authors.forename: Martin
authors.initials: M
authors.lastname: St John Sutton
authors.forename: Susan E
authors.initials: SE
authors.lastname: Wiegers
authors.forename: James N
authors.initials: JN
authors.lastname: Kirkpatrick
mesh_terms: D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging*; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D006801:Humans; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D019564:Unnecessary Procedures / Q000706:statistics & numerical data