Appropriate Use Criteria for Paediatric Echocardiography – Applicability in a Resource Poor Setting in the Niger Delta Region of Nigeria

Abstract

Aims: To make comparative analysis of the indications and outcome of paediatric echocardiography in tertiary centers in Rivers State, Nigeria using the Appropriate Use Criteria (AUC) guidelines [11]. 
 Methodology: A retrospective analysis of 645 echocardiography requests done between July 2019 to June 2020. Patients’ biodata and indications for echocardiography and echocardiography diagnosis were retrieved. Using the AUC guidelines, each indication was scored from 1 to 9, after which they were categorized into Appropriate, May be appropriate and Rarely appropriate to determine the respective percentages accordingly. Cochran-Armitage test for trend was done to assess degree of yield of cardiac anomaly for each level of AUC classification while bivariate associations were assessed using persons chi squared tests.
 Results: There were 645 echocardiography requests within the study period. The median age was 5months, with interquartile range of 2months to 24months. There were 355(55%) males and 290(45%) females. The clinical indication for echocardiography was appropriate in 490(76.0%), May be appropriate in 32(5.0%) and Rarely appropriate in 104(16.1%). Nineteen (2.9%) clinical indications were “Unclassified” under the AUC. Echocardiography showed abnormality in 544(84.3%) reports, among which children with “Appropriate indications” had the highest yield 457(93.3%), while “unclassified indications” had the lowest yield 8(42.1%). The yield for cardiac anomalies significantly decreased with decreasing appropriateness (p=0.00001).
 Conclusion: Most indications for paediatric echocardiography in our centers were appropriate according to the AUC guidelines. The AUC guidelines are applicable in resource poor settings.