ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography
ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography
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DOI：
10.1016/j.jacc.2010.11.002
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发表时间：
2011-03-01
影响因子：
24
通讯作者：
Weiner, Rory B.
中科院分区：
文献类型：
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作者：
Douglas, Pamela S.;Garcia, Mario J.;Weiner, Rory B.
美国心脏病学会基金会（ACCF）与美国超声心动图学会（ASE）以及沿着主要专业和亚专业学会合作，对经常考虑超声心动图的常见临床情况进行了审查。本文件结合并更新了2007年发布的原始经胸和经食管超声心动图适用性标准（1）和2008年发布的原始负荷超声心动图适用性标准（2）。该修订版反映了新的临床数据，反映了试验使用模式的变化，并澄清了超声心动图在原始标准中存在遗漏或缺乏明确性的情况下的使用。适应症（临床场景）来自常见应用或预期用途，以及当前临床实践指南和检查原始适当使用标准（AUC）实施情况的研究结果。本文件中的202种适应症由不同的写作小组编写，并由一个单独的独立技术小组以1至9的评分标准进行评分，以指定适当的使用97个适应症被评定为适当，34个被评定为不确定，71个被评定为不适当。一般而言，当临床状态发生变化或预期超声心动图结果会改变患者管理时，使用超声心动图进行初步诊断被认为是适当的。当临床状态没有变化或检测结果不太可能改变管理时，常规检测更可能是不适当的，而不是适当/不确定的。超声心动图的AUC可能会影响医生的决策、医疗服务和报销政策。此外，识别不确定的临床情况有助于识别将从未来研究中受益的领域。
The American College of Cardiology Foundation (ACCF), in partnership with the American Society of Echocardiography (ASE) and along with key specialty and subspecialty societies, conducted a review of common clinical scenarios where echocardiography is frequently considered. This document combines and updates the original transthoracic and transesophageal echocardiography appropriateness criteria published in 2007 (1) and the original stress echocardiography appropriateness criteria published in 2008 (2). This revision reflects new clinical data, reflects changes in test utilization patterns, and clarifies echocardiography use where omissions or lack of clarity existed in the original criteria.The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of the original appropriate use criteria (AUC). The 202 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9, to designate appropriate use (median 7 to 9), uncertain use (median 4 to 6), and inappropriate use (median 1 to 3).Ninety-seven indications were rated as appropriate, 34 were rated as uncertain, and 71 were rated as inappropriate. In general, the use of echocardiography for initial diagnosis when there is a change in clinical status or when the results of the echocardiogram are anticipated to change patient management were rated appropriate. Routine testing when there was no change in clinical status or when results of testing were unlikely to modify management were more likely to be inappropriate than appropriate/uncertain.The AUC for echocardiography have the potential to impact physician decision making, healthcare delivery, and reimbursement policy. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research.