title: Appropriate use criteria for echocardiography in the Netherlands.
abstract: BACKGROUND
  Appropriate use criteria (AUC) for echocardiography based on clinical scenarios were previously published by an American Task Force. We determined whether members of the Dutch Working Group on Echocardiography (WGE) would rate these scenarios in a similar way.
  
  
  METHODS
  All 32 members of the WGE were invited to judge clinical scenarios independently using a blanked version of the previously published American version of AUC for echocardiography. During a face-to-face meeting, consensus about the final rating was reached by open discussion for each indication. For reasons of simplicity, the scores were reduced from a 9-point scale to a 3-point scale (indicating an appropriate, uncertain or inappropriate echo indication, respectively).
  
  
  RESULTS
  Nine cardiologist members of the WGE reported their judgment on the echo cases (n = 153). Seventy-one indications were rated as appropriate, 35 were rated as uncertain, and 47 were rated as inappropriate. In 5% of the cases the rating was opposite to that in the original (appropriate compared with inappropriate and vice versa), whereas in 20% judgements differed by 1 level of appropriateness. After the consensus meeting, the appropriateness of 7 (5%) cases was judged differently compared with the original paper.
  
  
  CONCLUSIONS
  Echocardiography was rated appropriate when it is applied for an initial diagnosis, a change in clinical status or a change in patient management. However, in about 5% of the listed clinical scenarios, members of the Dutch WGE rated the AUC for echocardiography differently as compared with their American counterparts. Further research is warranted to analyse this decreased external validity.
authors.affiliation: Department of Cardiology, AMC, Amsterdam, The Netherlands. b.j.bouma@amc.uva.nl.
authors.forename: B J
authors.initials: BJ
authors.lastname: Bouma
authors.affiliation: Department of Cardiology, OLVG, Amsterdam, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Riezenbos
authors.affiliation: Department of Cardiology, Spaarne Hospital, Hoofddorp, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Voogel
authors.affiliation: Department of Cardiology, Isala, Zwolle, The Netherlands.
authors.forename: M H
authors.initials: MH
authors.lastname: Veldhorst
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Jaarsma
authors.affiliation: Department of Cardiology, St Antonius Hospital, Sneek, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Hrudova
authors.affiliation: Department of Cardiology, St Antonius Hospital, Sneek, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Cernohorsky
authors.affiliation: Department of Cardiology, University Medical Center, Utrecht, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Chamuleau
authors.affiliation: Department of Cardiology, AMC, Amsterdam, The Netherlands.
authors.forename: R B A
authors.initials: RBA
authors.lastname: van den Brink
authors.affiliation: Department of Cardiology, MCL, Leeuwarden, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Breedveld
authors.affiliation: Department of Cardiology, MCA, Alkmaar, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Reichert
authors.affiliation: Department of Cardiology, VUmc and AMC, Amsterdam, The Netherlands.
authors.forename: O
authors.initials: O
authors.lastname: Kamp
authors.affiliation: Department of Cardiology, Gelre Hospitals, Apeldoorn, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Braam
authors.affiliation: Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: van Melle
keywords: Appropriate use criteria; Cardiac imaging; Diagnostic testing; Echocardiography