Application of the Pediatric Appropriate Use Criteria for Chest Pain

Tuan Nguyen, Michael P. Fundora, Elizabeth Welch, Pamela S. Douglas, Benjamin W. Eidem, Robert M. Campbell, Rory B. Weiner, Kenan W D Stern, Oscar J. Benavidez, Wyman W. Lai, Ritu Sachdeva, Leo Lopez

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: To characterize the subgroup of outpatient pediatric patients presenting with chest pain and to determine the effectiveness of published pediatric appropriate use criteria (PAUC) to detect pathology. Study design: The Pediatric Appropriate Use of Echocardiography study evaluated the use and yield of transthoracic echocardiography (TTE) before and after PAUC release. Data were reviewed on patients ≤18 years of age who underwent TTE for chest pain. Indications were classified as appropriate (A), may be appropriate (M), and rarely appropriate (R) based on PAUC ratings, and findings were normal, incidental, or abnormal. Results: Chest pain was the primary indication in 772 of 4562 outpatient TTE studies (17%) (median age 14 years, IQR 10-16) ordered during the study period: 458 of 772 before (59%) and 314 of 772 after (41 %) the release of PAUC with no change in appropriateness. In A indications (n = 654), 642 (98%) were normal, 5 (1%) had incidental findings, and 7 (1%) were abnormal. A and M detected 100% of all abnormal findings (A: n = 7; M: n = 6; R: n = 0), with an association between ratings and findings (P <. .001). There was no association between R rating and any pathology. Conclusions: There was no change in ordering patterns with publication of the PAUC. Despite the high rate of TTEs ordered for indications rated A, most studies were normal. Studies that detected pathology were performed for indications rated A or M, but not R. This study supports PAUC as a useful tool in pediatric chest pain evaluation that may subsequently improve the use of TTE.

Original languageEnglish (US)
JournalJournal of Pediatrics
DOIs
StateAccepted/In press - Oct 11 2016

Fingerprint

Chest Pain
Pediatrics
Echocardiography
Pathology
Outpatients
Incidental Findings
Publications

Keywords

  • Chest pain
  • Echocardiography
  • Outpatient
  • Pediatric cardiology

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Nguyen, T., Fundora, M. P., Welch, E., Douglas, P. S., Eidem, B. W., Campbell, R. M., ... Lopez, L. (Accepted/In press). Application of the Pediatric Appropriate Use Criteria for Chest Pain. Journal of Pediatrics. https://doi.org/10.1016/j.jpeds.2017.02.073

Application of the Pediatric Appropriate Use Criteria for Chest Pain. / Nguyen, Tuan; Fundora, Michael P.; Welch, Elizabeth; Douglas, Pamela S.; Eidem, Benjamin W.; Campbell, Robert M.; Weiner, Rory B.; Stern, Kenan W D; Benavidez, Oscar J.; Lai, Wyman W.; Sachdeva, Ritu; Lopez, Leo.

In: Journal of Pediatrics, 11.10.2016.

Research output: Contribution to journalArticle

Nguyen, T, Fundora, MP, Welch, E, Douglas, PS, Eidem, BW, Campbell, RM, Weiner, RB, Stern, KWD, Benavidez, OJ, Lai, WW, Sachdeva, R & Lopez, L 2016, 'Application of the Pediatric Appropriate Use Criteria for Chest Pain', Journal of Pediatrics. https://doi.org/10.1016/j.jpeds.2017.02.073
Nguyen T, Fundora MP, Welch E, Douglas PS, Eidem BW, Campbell RM et al. Application of the Pediatric Appropriate Use Criteria for Chest Pain. Journal of Pediatrics. 2016 Oct 11. https://doi.org/10.1016/j.jpeds.2017.02.073
Nguyen, Tuan ; Fundora, Michael P. ; Welch, Elizabeth ; Douglas, Pamela S. ; Eidem, Benjamin W. ; Campbell, Robert M. ; Weiner, Rory B. ; Stern, Kenan W D ; Benavidez, Oscar J. ; Lai, Wyman W. ; Sachdeva, Ritu ; Lopez, Leo. / Application of the Pediatric Appropriate Use Criteria for Chest Pain. In: Journal of Pediatrics. 2016.
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abstract = "Objectives: To characterize the subgroup of outpatient pediatric patients presenting with chest pain and to determine the effectiveness of published pediatric appropriate use criteria (PAUC) to detect pathology. Study design: The Pediatric Appropriate Use of Echocardiography study evaluated the use and yield of transthoracic echocardiography (TTE) before and after PAUC release. Data were reviewed on patients ≤18 years of age who underwent TTE for chest pain. Indications were classified as appropriate (A), may be appropriate (M), and rarely appropriate (R) based on PAUC ratings, and findings were normal, incidental, or abnormal. Results: Chest pain was the primary indication in 772 of 4562 outpatient TTE studies (17{\%}) (median age 14 years, IQR 10-16) ordered during the study period: 458 of 772 before (59{\%}) and 314 of 772 after (41 {\%}) the release of PAUC with no change in appropriateness. In A indications (n = 654), 642 (98{\%}) were normal, 5 (1{\%}) had incidental findings, and 7 (1{\%}) were abnormal. A and M detected 100{\%} of all abnormal findings (A: n = 7; M: n = 6; R: n = 0), with an association between ratings and findings (P <. .001). There was no association between R rating and any pathology. Conclusions: There was no change in ordering patterns with publication of the PAUC. Despite the high rate of TTEs ordered for indications rated A, most studies were normal. Studies that detected pathology were performed for indications rated A or M, but not R. This study supports PAUC as a useful tool in pediatric chest pain evaluation that may subsequently improve the use of TTE.",
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