title: Appropriateness and diagnostic yield of inpatient pediatric echocardiograms.
abstract: OBJECTIVE
  Multiple reports have shown echocardiograms for certain indications are neither cost-effective nor of high diagnostic yield. Given the ease with which tests can be obtained at a tertiary academic children's hospital, our aims were to: (1) determine the diagnostic yield of inpatient studies by in-hospital location; (2) evaluate inpatient echocardiograms to determine indications and level of appropriateness; and (3) evaluate the frequency of cardiology involvement prior to those echocardiograms.
  
  
  METHODS
  All initial inpatient echocardiograms interpreted at our institution from February 2009 to December 2014 were reviewed retrospectively. Patient location was grouped as pediatric intensive care (PICU), emergency department (ED), and general floor.
  
  
  RESULTS
  There were 727 first-time inpatient echocardiograms that met inclusion criteria. Pathology was identified in 25% of the study echocardiograms, with 11% of all studies demonstrating pathology that could alter patient management (moderate or severe pathology). The studies performed in the PICU and ED had more severe pathology compared with those from the general floor (P < .001, .003; respectively). Few echocardiograms were performed for rarely appropriate indications on the general floor (7%) and PICU (2.2%). Over 75% of general floor echocardiograms performed for a pathologic murmur yielded normal or incidental findings. Cardiology consultation was documented in only 7.5% of general floor studies.
  
  
  CONCLUSIONS
  The diagnostic yield of inpatient, first-time pediatric echocardiograms is relatively low. The majority of studies that identified pathology were performed on patients located in higher acuity units. General floor echocardiograms for murmurs had a low diagnostic yield, raising the question of cardiology consultation versus direct echocardiogram ordering for subjective physical exam signs.
authors.affiliation: Arkansas Children's Hospital, Little Rock, Arkansas, USA.|Arkansas Children's Research Institute, Little Rock, Arkansas, USA.|University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Lang
authors.affiliation: Arkansas Children's Hospital, Little Rock, Arkansas, USA.|Arkansas Children's Research Institute, Little Rock, Arkansas, USA.|University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Elijah
authors.initials: E
authors.lastname: Bolin
authors.affiliation: Arkansas Children's Hospital, Little Rock, Arkansas, USA.|Arkansas Children's Research Institute, Little Rock, Arkansas, USA.|University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Daily
authors.affiliation: Arkansas Children's Hospital, Little Rock, Arkansas, USA.|Arkansas Children's Research Institute, Little Rock, Arkansas, USA.|University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Tang
authors.affiliation: Arkansas Children's Hospital, Little Rock, Arkansas, USA.|Arkansas Children's Research Institute, Little Rock, Arkansas, USA.|University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: R
authors.initials: R
authors.lastname: Thomas Collins
mesh_terms: D000293:Adolescent; D001131:Arkansas; D016507:Cardiology Service, Hospital; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D015278:Intensive Care Units, Pediatric; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D019564:Unnecessary Procedures; D055815:Young Adult
keywords: cardiology consultation; echocardiogram indications; general floor; murmur