Appropriate Use Criteria for paediatric echocardiography in an outpatient practice: a validation study

Abstract

The Appropriate Use Criteria can be used to safely reduce echocardiography volume while still detecting significant heart disease.

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

“…It is noteworthy that amongst those who were appropriately referred for echocardiography in this study, there was a high yield of 93.3% for cardiac anomalies and the yield tended to decrease with decreasing levels of appropriateness such that those with rarely appropriate or unclassified indication had the lowest yield for cardiac anomalies. This is in contrast to a study by Catoski et al [16] in Baltimore where the yield for abnormal echocardiography amongst those with appropriate indication was much lower at 16.1%. This huge difference may be related to the differences in the common "specific' indications for echocardiography between the two studies as the present study recorded murmur and presence of clinical signs & symptoms which are related to structural heart diseases, while the study by Catoski et al [16] had systemic disorders as the most common indication, which usually take a long time of disease progression for cardiac anomalies to manifest either late in childhood or well into adulthood.…”

“…This is in contrast to a study by Catoski et al [16] in Baltimore where the yield for abnormal echocardiography amongst those with appropriate indication was much lower at 16.1%. This huge difference may be related to the differences in the common "specific' indications for echocardiography between the two studies as the present study recorded murmur and presence of clinical signs & symptoms which are related to structural heart diseases, while the study by Catoski et al [16] had systemic disorders as the most common indication, which usually take a long time of disease progression for cardiac anomalies to manifest either late in childhood or well into adulthood. This difference is also reflected in the much younger and older median ages of the two studies at 5 months and 11 years [16] respectively.…”

“…This huge difference may be related to the differences in the common "specific' indications for echocardiography between the two studies as the present study recorded murmur and presence of clinical signs & symptoms which are related to structural heart diseases, while the study by Catoski et al [16] had systemic disorders as the most common indication, which usually take a long time of disease progression for cardiac anomalies to manifest either late in childhood or well into adulthood. This difference is also reflected in the much younger and older median ages of the two studies at 5 months and 11 years [16] respectively. Also, younger children are more likely to have cardiac referrals from suspicion of congenital cardiac defects when compared older children who are more likely to have other pathologies that could mimic a cardiovascular disorder and thus result in a lower yield of abnormal echocardiography.…”

“…It is interesting to note that the common indications for echocardiography in this study (pathologic murmur and presence of symptoms and signs of cardiac disease) is quite difference from those in studies done in the developed countries (systemic disorders and syncope) as observed Catoski et al [16]. The reason for this may be due to existence of newborn screening for CHD in developed countries resulting in early detection and intervention.…”

Telehealth and Application of Appropriate Use Criteria for Pediatric Transthoracic Echocardiography

“…The authors evaluated 1383 TTEs done at the initial outpatient visit and found 16.4% of patients met criteria for the R group. They noted that the most common R indications included innocent murmurs; palpitations without additional symptoms with a benign history and ECG; and syncope with no significant family history, normal ECG, and no other symptoms [8]. Our study is among the first to assess adherence to AUC in telehealth visits, and the consistent over utilization of echocardiography in patients with cardiac murmurs highlights a gap in our current practices.…”