title: Application of the Pediatric Appropriate Use Criteria for Chest Pain.
abstract: To characterize the subgroup of outpatient pediatric patients presenting with chest pain and to determine the effectiveness of published pediatric appropriate use criteria (PAUC) to detect pathology.
  
  
  
  The Pediatric Appropriate Use of Echocardiography study evaluated the use and yield of transthoracic echocardiography (TTE) before and after PAUC release. Data were reviewed on patients ?18 years of age who underwent TTE for chest pain. Indications were classified as appropriate (A), may be appropriate (M), and rarely appropriate (R) based on PAUC ratings, and findings were normal, incidental, or abnormal.
  
  
  
  Chest pain was the primary indication in 772 of 4562 outpatient TTE studies (17%) (median age 14 years, IQR 10-16) ordered during the study period: 458 of 772 before (59%) and 314 of 772 after (41 %) the release of PAUC with no change in appropriateness. In A indications (n?=?654), 642 (98%) were normal, 5 (1%) had incidental findings, and 7 (1%) were abnormal. A and M detected 100% of all abnormal findings (A: n?=?7; M: n?=?6; R: n?=?0), with an association between ratings and findings (P?<.001). There was no association between R rating and any pathology.
  
  
  
  There was no change in ordering patterns with publication of the PAUC. Despite the high rate of TTEs ordered for indications rated A, most studies were normal. Studies that detected pathology were performed for indications rated A or M, but not R. This study supports PAUC as a useful tool in pediatric chest pain evaluation that may subsequently improve the use of TTE.
authors.affiliation: Nicklaus Children's Hospital, Miami, FL. Electronic address: drnguyen@kansaskidsheartcenter.com.
authors.forename: Tuan
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Nicklaus Children's Hospital, Miami, FL.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Fundora
authors.affiliation: Nicklaus Children's Hospital, Miami, FL.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Welch
authors.affiliation: Duke University, Durham, NC.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Eidem
authors.affiliation: Emory University School of Medicine, Children's Healthcare of Atlanta Sibley Heart Center Cardiology, Atlanta, GA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Campbell
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Rory B
authors.initials: RB
authors.lastname: Weiner
authors.affiliation: Children's Hospital at Montefiore, Bronx, NY.
authors.forename: Kenan W D
authors.initials: KWD
authors.lastname: Stern
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Benavidez
authors.affiliation: Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY.
authors.forename: Wyman W
authors.initials: WW
authors.lastname: Lai
authors.affiliation: Emory University School of Medicine, Children's Healthcare of Atlanta Sibley Heart Center Cardiology, Atlanta, GA.
authors.forename: Ritu
authors.initials: R
authors.lastname: Sachdeva
authors.affiliation: Nicklaus Children's Hospital, Miami, FL.
authors.forename: Leo
authors.initials: L
authors.lastname: Lopez
mesh_terms: D000293:Adolescent; D002637:Chest Pain / Q000209:etiology*; D002648:Child; D003430:Cross-Sectional Studies; D004452:Echocardiography / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006330:Heart Defects, Congenital / Q000175:diagnosis; D006331:Heart Diseases / Q000175:diagnosis; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D014481:United States
keywords: chest pain; echocardiography; outpatient; pediatric cardiology