The Use of Echocardiography for Pediatric Patients Presenting with Syncope

Pelletier, Jonathan; Blanchard, Sarah; Chamberlain, Reid C.; Hornik, Christoph P.; Campbell, Michael J.; Hill, Kevin D.

doi:10.1016/j.jpeds.2017.07.010

Cited by 6 publications

(7 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For patients with more than one indication for the TTE, the most clinically significant indication was designated as the main reason for TTE. The corresponding appropriateness rating for each TTE was using the AUC guidelines as “appropriate,” “may be appropriate,” or “rarely appropriate.” Consistent with prior studies, 5-8,10 TTE findings were classified as normal, incidental, or abnormal. Incidental findings included peripheral pulmonary artery stenosis, left superior vena cava, tiny coronary artery fistula, tiny patent ductus arteriosus in the absence of a murmur, retroaortic innominate vein, common origin of innominate artery and left common carotid artery, left aortic arch with aberrant subclavian, and patent foramen ovale.…”

Section: Methodsmentioning

confidence: 64%

“…In fact, although not addressed with this study, the majority of patients seen with syncope are managed by their PCP and do not get referred to pediatric cardiology. 7,8 We did not assess the ordering rate by PCPs, as it was beyond the scope of this investigation.…”

Section: Discussionmentioning

confidence: 99%

“…The vast majority of patients with syncope have benign etiologies, 2-4 yet these patients often undergo extensive, costly testing with a very low diagnostic yield. While there is literature assessing pediatric cardiologists for the appropriateness of TTE orders in syncope and other cardiac diagnoses, 5-8 there have not been any comparisons between PCPs and pediatric cardiologists for syncope specifically. Also, to the authors’ knowledge, there is no literature with regard to these AUC, syncope, and cost-effectiveness, although there is one study addressing cost-effectiveness of TTE ordered for chest pain.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Appropriateness and Cost-Effectiveness of Echocardiograms Ordered by Pediatric Cardiologists and Primary Care Providers for Syncope

Thompson

Hasselman

Wang

et al. 2021

Clin Pediatr (Phila)

View full text Add to dashboard Cite

The pediatric appropriate use criteria (AUC) were applied to transthoracic echocardiograms (TTE) ordered by primary care providers (PCPs) and pediatric cardiologists for the diagnosis of syncope to compare appropriateness ratings and cost-effectiveness. Included were patients ≤18 years of age from October 2016 to October 2018 with syncope who underwent initial outpatient pediatric TTE ordered by a PCP or were seen in Pediatric Cardiology clinic. Ordering rate of TTE by pediatric cardiologists, AUC classification, and TTE findings were obtained. PCPs ordered significantly more TTEs than pediatric cardiologists for “rarely appropriate” indications (61.5% vs 7.5%, P < .001). Cardiologists ordered TTEs at 17.2% of visits. Using appropriateness as a marker of effect, with the incremental cost-effectiveness ratio, it was more cost-effective ($543.33 per patient) to refer to a pediatric cardiologist than to order the TTE alone. This suggests that improved PCP education of the AUC and appropriate indications of TTEs for syncope may improve cost-effectiveness when using order appropriateness as a marker of effectiveness.

show abstract

Section: Methodsmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Appropriateness and Cost-Effectiveness of Echocardiograms Ordered by Pediatric Cardiologists and Primary Care Providers for Syncope

Thompson

Hasselman

Wang

et al. 2021

Clin Pediatr (Phila)

View full text Add to dashboard Cite

show abstract

“…Similar studies have also been performed on the diagnostic yield of echocardiograms performed for chest pain and syncope according to the appropriate use criteria, reaffirming low diagnostic yield in echocardiograms for the "rarely appropriate" indications. 7,8 Preliminary studies assessing paediatric appropriate use criteria did show that a greater percentage of patients with abnormal echocardiograms had an "appropriate" indication for echocardiography; however, patient outcomes and management decisions were not studied. 5 Measuring patient outcomes and management decisions is the next step in evaluating the paediatric appropriate use criteria, as our data indicate that the appropriate use criteria may need to be re-evaluated to be more stringent, especially for palpitation-related indications.…”

Section: Discussionmentioning

confidence: 99%

Appropriate use of echocardiography for palpitations in paediatric cardiology clinics

et al. 2020

View full text Add to dashboard Cite

Objectives: Identify diagnostic yield and frequency of echocardiograms for palpitation-related indications at outpatient paediatric cardiology clinics in relation to the 2014 ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE appropriate use criteria for Initial Transthoracic Echocardiography in Outpatient Paediatric Cardiology. Study design: A single-centre, retrospective study of children presenting for evaluation of a chief complaint of palpitations to outpatient paediatric cardiology clinics from 2015 to 2017. Palpitations were defined as an unpleasant sensation of rapid, irregular, and/or forceful beating of the heart. Indications for echocardiogram in patients were retrospectively classified based on the appropriate use criteria as “appropriate,” “may be appropriate,” or “rarely appropriate.” The incidence of abnormal and incidental echocardiographic findings for each category was determined. Results: A total of 286 patients presented with palpitations, with 128 (52% female) meeting inclusion criteria. Exclusion criteria included patients with additional cardiac complaints, prior echocardiogram, or history of congenital heart disease. Echocardiograms were performed on 36 (28%) patients. The appropriate use criteria were retrospectively applied, and indications for their performance were classified as “appropriate” (n = 4), “may be appropriate” (n = 17), or “rarely appropriate” (n = 15). Minor echocardiographic abnormalities were present in 22% (n = 8) of echocardiograms obtained for all appropriate use criteria classifications. No moderate or severe echocardiographic abnormalities were found. Incidental findings were noted in eight echocardiograms. Conclusion: Echocardiography in the evaluation of “rarely appropriate” and “may be appropriate” palpitation-related indications is of low diagnostic yield.

show abstract

“…Nur bei ca. 0,5-2 % der Synkopen finden sich pathologische Befunde, die potenziell über die Echokardiographie erhoben werden können [14,22,25,29,31]. In unserer Studie war die Echokardiographie mit 69,5 % die zweithäufigste eingesetzte apparative Untersuchung, wobei diese in 45,1 % der Fälle nicht indiziert war.…”

Section: Diskussionunclassified

Synkopenabklärung bei Kindern und Jugendlichen – Handeln wir gemäß der aktuellen Leitlinie?

Landwehr

Meyer

Flotats‐Bastardas

et al. 2021

Wien Med Wochenschr

View full text Add to dashboard Cite

Zusammenfassung Hintergrund Synkopen im Kindes‑/Jugendalter sind häufig und meist gutartig. Mögliche kardiale Synkopen müssen durch sorgfältige Basisdiagnostik (Anamnese (I), körperliche Untersuchung (II), Elektrokardiografie (III)) und ggf. weiterführender Diagnostik ausgeschlossen werden. Fragestellung Wurde die Diagnostik bei Vorliegen einer Synkope entsprechend der gültigen S2k-Leitlinie durchgeführt? Material und Methoden Retrospektive Analyse (01/2015–12/2017), Kinderklinik des Universitätsklinikums des Saarlandes, Homburg, Deutschland. Eingeschlossen wurden alle Patienten von 1 bis 18 Jahre, die sich wegen Synkope vorstellten. Ergebnisse Es erlitten 262 Patienten eine Synkope (161 weiblich [61,5 %], 101 männlich [38,5 %], Alter 12,5 ± 3,9 Jahre); davon 183 (69,8 %) Reflexsynkopen, 36 (13,7 %) Präsynkopen, 35 (13,4 %) Synkopen unklarer Genese, 8 (3,1 %) kardiale Synkopen; 43/262 Patienten (16,4 %) erhielten eine vollständiger Basisdiagnostik (I–III) gemäß Leitlinie, 13/43 (30,2 %) wurden korrekt weiterführender Diagnostik zugeführt; 219/262 Patienten (83,6 %) erhielten keine ausreichende Basisdiagnostik (I–III), 135/219 (61,6 %) wurden unnötigen apparativen Untersuchungen zugeführt. Diskussion Die leitlinienkonforme Synkopenabklärung ist wichtig, um unnötige, aber auch nicht ausreichende Diagnostik zu vermeiden und somit Patienten mit Synkope korrekt zu diagnostizieren.

show abstract

The Use of Echocardiography for Pediatric Patients Presenting with Syncope

Cited by 6 publications

References 13 publications

Appropriateness and Cost-Effectiveness of Echocardiograms Ordered by Pediatric Cardiologists and Primary Care Providers for Syncope

Appropriateness and Cost-Effectiveness of Echocardiograms Ordered by Pediatric Cardiologists and Primary Care Providers for Syncope

Appropriate use of echocardiography for palpitations in paediatric cardiology clinics

Synkopenabklärung bei Kindern und Jugendlichen – Handeln wir gemäß der aktuellen Leitlinie?

Contact Info

Product

Resources

About