title: Comparison of cardiac computed tomography examination appropriateness under the 2010 revised versus the 2006 original Appropriate Use Criteria.
abstract: BACKGROUND
  The 2006 Cardiac CT Appropriate Use Criteria (AUC) were recently revised in 2010. In addition to rating an expanded number of indications, the new criteria adjusted the appropriateness of existing indications to reflect changes in clinical practice and new evidence since 2006.
  
  
  OBJECTIVE
  We sought to determine how the appropriateness of cardiac CT examinations performed at a tertiary-care hospital changed under the revised criteria compared with the original AUC.
  
  
  METHODS
  Data were collected from the medical records and personal interview of 267 consecutive patients referred for cardiac CT in 2008. With the use of the 2010 and 2006 AUCs, two physicians designated each examination's indication as appropriate, inappropriate, uncertain, or "not classified" if examination indication could not be assigned.
  
  
  RESULTS
  With the use the new 2010 AUC, a highly significant change was observed in the classification of examination appropriateness (P < 0.001), with 40% of examinations changing appropriateness level compared with the 2006 AUC. Under the 2010 AUC, there were an increased proportion of both appropriate examinations (59% vs. 45%; P < 0.001) and inappropriate examinations (15% vs. 10%; P < 0.001), and approximately the same proportion with uncertain appropriateness (13% vs. 16%; P = 0.33). Consequently, the proportion of examinations that were not classified was significantly reduced under the 2010 AUC (29% vs. 13%; P < 0.001).
  
  
  CONCLUSIONS
  The revision of the AUC for cardiac CT had a significant effect on examination appropriateness. In comparison to the 2006 AUC, the 2010 AUC provided improved clarification of examination appropriateness. This shift was because of the inclusion of many previously unaddressed indications and the designation of more examinations as either appropriate or inappropriate.
authors.affiliation: Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, PB 147, Boston, MA 02115, USA.
authors.forename: Meagan M
authors.initials: MM
authors.lastname: Wasfy
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Brady
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Ricardo C
authors.initials: RC
authors.lastname: Cury
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods* / Q000592:standards; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D019983:Guideline Adherence; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000592:standards; D019564:Unnecessary Procedures