Appropriate Use Criteria for paediatric echocardiography in an outpatient practice: a validation study.
Appropriate Use Criteria for paediatric echocardiography in an outpatient practice: a validation study.
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门诊儿科超声心动图的适当使用标准：验证研究。
DOI：
10.1017/s1047951118000513
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发表时间：
2018
影响因子：
1
通讯作者：
Spevak,PhilipJ
中科院分区：
文献类型：
--
作者：
Cartoski,MarkJ;Kiley,Meghan;Spevak,PhilipJ
背景虽然经胸超声心动图是 CHD 的主要成像方式，但最佳应用尚不清楚。我们评估了遵守门诊经胸超声心动图的儿科适当使用标准是否可以减少不适当使用，而不会漏掉重大心脏病。方法使用适当使用标准，我们确定了 2014 年期间在我们机构进行的每次初始超声心动图的适应症和适当性评级（N = 1383）。图表审查记录了订购提供者的培训、患者人口统计数据和研究结果，在 2 年随访期内分为正常、异常或异常激励治疗。我们测试了提供者培训水平或患者年龄是否与超声心动图结果或适当性评级相关。结果我们发现 83.9% 的超声心动图正常，66.7% 有适当的指征。几乎所有异常结果和所有促使治疗的结果均来自适当的研究，如果存在适当的指征，则异常结果的比值比为 2.73（95% 置信区间 1.92–3.89，p<0.001）。其余的初始异常结果均未出现显着的适应症，导致治疗超过 2 年。结果表明，应用该标准后，成像体积可能减少多达 33%。心脏病专家要求进行几乎所有导致治疗的研究，但也要求进行更多适应症不太合适的超声心动图检查。大多数检查对象是老年患者；然而，大多数异常结果发生在 1 岁以下的患者中。 结论 适当的使用标准可用于安全地减少超声心动图体积，同时仍可检测出明显的心脏病。
BackgroundAlthough transthoracic echocardiography is the dominant imaging modality in CHD, optimal utilisation is unclear. We assessed whether adherence to the paediatric Appropriate Use Criteria for outpatient transthoracic echocardiography could reduce inappropriate use without missing significant cardiac disease.MethodsUsing the Appropriate Use Criteria, we determined the indication and appropriateness rating for each initial echocardiogram performed at our institution during calendar year 2014 (N=1383). Chart review documented ordering provider training, patient demographics, and study result, classified as normal, abnormal, or abnormal motivating treatment within a 2-year follow-up period. We tested whether provider training level or patient age correlated with echocardiographic findings or appropriateness rating.ResultsWe found that 83.9% of echocardiograms were normal and that 66.7% had an appropriate indication. Nearly all abnormal results and all results motivating treatment were in appropriate studies, giving an odds ratio of 2.73 for an abnormal result if an appropriate indication was present (95% confidence interval 1.92–3.89, p<0.001). None of the remaining initial abnormal results with less than appropriate indications became significant, resulting in treatment over 2 years. Results suggest a potential reduction in imaging volume of as much as 33% with application of the criteria. Cardiologists ordered nearly all studies resulting in treatment but also more echocardiograms with less appropriate indications. Most examinations were in older patients; however, most abnormal results were in patients younger than 1 year.ConclusionsThe Appropriate Use Criteria can be used to safely reduce echocardiography volume while still detecting significant heart disease.