title: Comparison of the updated 2011 appropriate use criteria for echocardiography to the original criteria for transthoracic, transesophageal, and stress echocardiography.
abstract: BACKGROUND
  The aim of this study was to compare appropriateness designations as determined by the updated 2011 appropriate use criteria (AUC) for echocardiography with prior versions of the AUC for transthoracic echocardiographic (TTE) imaging, transesophageal echocardiographic (TEE) imaging, and stress echocardiographic (SE) imaging. An additional goal was to define relationships between appropriateness determinations and echocardiographic findings for each modality.
  
  
  METHODS
  Previously published data sets of TTE, TEE, and SE studies were reclassified according to the 2011 AUC, and indication representation, appropriateness designations, and echocardiographic findings were compared with prior classifications according to the 2007 AUC for TTE and TEE imaging and the 2008 AUC for SE imaging.
  
  
  RESULTS
  Overall, 2,247 echocardiographic studies were analyzed. The 2011 AUC addressed the vast majority of studies (98%), a marked increase compared with prior versions of the AUC (89%) (P < .001). An increase in addressed studies was present in each echocardiographic modality (TTE imaging: n = 1,525, 98% vs 89%, P < .001; TEE imaging: n = 405, 99.7% vs 91%, P < .01; SE imaging: n = 289, 97% vs 88%, P < .01). Among all echocardiographic procedures, the 2011 AUC found a lower frequency of appropriate studies compared with prior AUC (82% vs 88%, P < .01), primarily because of new uncertain indications for TTE imaging. The frequency of inappropriate echocardiographic studies was unchanged (11%). Among all echocardiographic procedures, the 2011 AUC found appropriate studies to have more new abnormal echocardiographic findings compared with inappropriate studies (45% vs 13%, P < .001). Interestingly, 2011 AUC inappropriate TTE studies had fewer major new echocardiographic abnormalities than 2007 AUC inappropriate TTE studies (9% vs 17%, P = .04).
  
  
  CONCLUSIONS
  The updated 2011 AUC for echocardiography encompass the vast majority of echocardiographic procedures in a university hospital practice, filling virtually all of the gaps identified in prior versions of the AUC for TTE, TEE, and SE imaging. The 2011 AUC also reasonably stratify the likelihood of finding an echocardiographic abnormality, demonstrating improvement compared with the prior AUC.
authors.affiliation: Non-Invasive Imaging Laboratories, Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
authors.forename: Ibrahim N
authors.initials: IN
authors.lastname: Mansour
authors.forename: Rabia R
authors.initials: RR
authors.lastname: Razi
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Bhave
authors.forename: R Parker
authors.initials: RP
authors.lastname: Ward
mesh_terms: D002986:Clinical Trials as Topic / Q000706:statistics & numerical data* / Q000639:trends; D025401:Echocardiography, Stress / Q000592:standards* / Q000639:trends; D017548:Echocardiography, Transesophageal / Q000592:standards* / Q000706:statistics & numerical data* / Q000639:trends; D019983:Guideline Adherence / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D017410:Practice Guidelines as Topic; D014481:United States