Pediatric Appropriate Use Criteria Implementation Project

A Multicenter Outpatient Echocardiography Quality Initiative

Ritu Sachdeva, Joseph Allen, Oscar J. Benavidez, Robert M. Campbell, Pamela S. Douglas, Benjamin W. Eidem, Lara Gold, Michael S. Kelleman, Leo Lopez, Courtney E. McCracken, Kenan W D Stern, Rory B. Weiner, Elizabeth Welch, Wyman W. Lai

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background Recently published appropriate use criteria (AUC) for initial pediatric outpatient transthoracic echocardiography (TTE) have not yet been evaluated for clinical applicability. Objectives This study sought to determine the appropriateness of TTE as currently performed in pediatric cardiology clinics, diagnostic yield of TTE for various AUC indications, and any gaps in the AUC document. Methods Data were prospectively collected from patients undergoing initial outpatient TTE in 6 centers. TTE indications (appropriate [A], may be appropriate [M], or rarely appropriate [R]) and findings (normal, incidental, or abnormal) were recorded. Results Of the 2,655 studies ordered by 102 physicians, indications rated A, M, and R were found in 1,876 (71%), 316 (12%), and 319 studies (12%), respectively, and 144 studies (5%) were unclassifiable. Twenty-four of 113 indications (21%) were not used. Innocent murmur and syncope or palpitations with no other indications of cardiovascular disease, a benign family history, and normal electrocardiogram accounted for 75% of indications rated R. Pathologic murmur had the highest yield of abnormal findings (40%). Odds of an abnormal finding in an A or M TTE were 6 times that of R (95% confidence interval [CI]: [2.8 to 12.8]). Abnormal findings were more common in patients <1 year of age than in those >10 years of age (odds ratio: 6.4; 95% CI: 4.7 to 8.7). Age was a significant predictor of an abnormal finding after adjusting for indication and site (p < 0.001). Conclusions Most TTEs ordered in pediatric cardiology clinics were for indications rated A. AUC ratings successfully stratified indications based on the yield of abnormal findings. This study identified differences in the yield of TTE based on patient age and most common indications rated R. These findings should inform quality improvement efforts and future revisions of the AUC document.

Original languageEnglish (US)
Pages (from-to)1132-1140
Number of pages9
JournalJournal of the American College of Cardiology
Volume66
Issue number10
DOIs
StatePublished - Sep 8 2015

Fingerprint

Echocardiography
Outpatients
Pediatrics
Cardiology
Confidence Intervals
Heart Murmurs
Incidental Findings
Syncope
Quality Improvement
Electrocardiography
Cardiovascular Diseases
Odds Ratio
Physicians

Keywords

  • echocardiography
  • outpatient
  • pediatric cardiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Pediatric Appropriate Use Criteria Implementation Project : A Multicenter Outpatient Echocardiography Quality Initiative. / Sachdeva, Ritu; Allen, Joseph; Benavidez, Oscar J.; Campbell, Robert M.; Douglas, Pamela S.; Eidem, Benjamin W.; Gold, Lara; Kelleman, Michael S.; Lopez, Leo; McCracken, Courtney E.; Stern, Kenan W D; Weiner, Rory B.; Welch, Elizabeth; Lai, Wyman W.

In: Journal of the American College of Cardiology, Vol. 66, No. 10, 08.09.2015, p. 1132-1140.

Research output: Contribution to journalArticle

Sachdeva, R, Allen, J, Benavidez, OJ, Campbell, RM, Douglas, PS, Eidem, BW, Gold, L, Kelleman, MS, Lopez, L, McCracken, CE, Stern, KWD, Weiner, RB, Welch, E & Lai, WW 2015, 'Pediatric Appropriate Use Criteria Implementation Project: A Multicenter Outpatient Echocardiography Quality Initiative', Journal of the American College of Cardiology, vol. 66, no. 10, pp. 1132-1140. https://doi.org/10.1016/j.jacc.2015.06.1327
Sachdeva, Ritu ; Allen, Joseph ; Benavidez, Oscar J. ; Campbell, Robert M. ; Douglas, Pamela S. ; Eidem, Benjamin W. ; Gold, Lara ; Kelleman, Michael S. ; Lopez, Leo ; McCracken, Courtney E. ; Stern, Kenan W D ; Weiner, Rory B. ; Welch, Elizabeth ; Lai, Wyman W. / Pediatric Appropriate Use Criteria Implementation Project : A Multicenter Outpatient Echocardiography Quality Initiative. In: Journal of the American College of Cardiology. 2015 ; Vol. 66, No. 10. pp. 1132-1140.
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title = "Pediatric Appropriate Use Criteria Implementation Project: A Multicenter Outpatient Echocardiography Quality Initiative",
abstract = "Background Recently published appropriate use criteria (AUC) for initial pediatric outpatient transthoracic echocardiography (TTE) have not yet been evaluated for clinical applicability. Objectives This study sought to determine the appropriateness of TTE as currently performed in pediatric cardiology clinics, diagnostic yield of TTE for various AUC indications, and any gaps in the AUC document. Methods Data were prospectively collected from patients undergoing initial outpatient TTE in 6 centers. TTE indications (appropriate [A], may be appropriate [M], or rarely appropriate [R]) and findings (normal, incidental, or abnormal) were recorded. Results Of the 2,655 studies ordered by 102 physicians, indications rated A, M, and R were found in 1,876 (71{\%}), 316 (12{\%}), and 319 studies (12{\%}), respectively, and 144 studies (5{\%}) were unclassifiable. Twenty-four of 113 indications (21{\%}) were not used. Innocent murmur and syncope or palpitations with no other indications of cardiovascular disease, a benign family history, and normal electrocardiogram accounted for 75{\%} of indications rated R. Pathologic murmur had the highest yield of abnormal findings (40{\%}). Odds of an abnormal finding in an A or M TTE were 6 times that of R (95{\%} confidence interval [CI]: [2.8 to 12.8]). Abnormal findings were more common in patients <1 year of age than in those >10 years of age (odds ratio: 6.4; 95{\%} CI: 4.7 to 8.7). Age was a significant predictor of an abnormal finding after adjusting for indication and site (p < 0.001). Conclusions Most TTEs ordered in pediatric cardiology clinics were for indications rated A. AUC ratings successfully stratified indications based on the yield of abnormal findings. This study identified differences in the yield of TTE based on patient age and most common indications rated R. These findings should inform quality improvement efforts and future revisions of the AUC document.",
keywords = "echocardiography, outpatient, pediatric cardiology",
author = "Ritu Sachdeva and Joseph Allen and Benavidez, {Oscar J.} and Campbell, {Robert M.} and Douglas, {Pamela S.} and Eidem, {Benjamin W.} and Lara Gold and Kelleman, {Michael S.} and Leo Lopez and McCracken, {Courtney E.} and Stern, {Kenan W D} and Weiner, {Rory B.} and Elizabeth Welch and Lai, {Wyman W.}",
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T1 - Pediatric Appropriate Use Criteria Implementation Project

T2 - A Multicenter Outpatient Echocardiography Quality Initiative

AU - Sachdeva, Ritu

AU - Allen, Joseph

AU - Benavidez, Oscar J.

AU - Campbell, Robert M.

AU - Douglas, Pamela S.

AU - Eidem, Benjamin W.

AU - Gold, Lara

AU - Kelleman, Michael S.

AU - Lopez, Leo

AU - McCracken, Courtney E.

AU - Stern, Kenan W D

AU - Weiner, Rory B.

AU - Welch, Elizabeth

AU - Lai, Wyman W.

PY - 2015/9/8

Y1 - 2015/9/8

N2 - Background Recently published appropriate use criteria (AUC) for initial pediatric outpatient transthoracic echocardiography (TTE) have not yet been evaluated for clinical applicability. Objectives This study sought to determine the appropriateness of TTE as currently performed in pediatric cardiology clinics, diagnostic yield of TTE for various AUC indications, and any gaps in the AUC document. Methods Data were prospectively collected from patients undergoing initial outpatient TTE in 6 centers. TTE indications (appropriate [A], may be appropriate [M], or rarely appropriate [R]) and findings (normal, incidental, or abnormal) were recorded. Results Of the 2,655 studies ordered by 102 physicians, indications rated A, M, and R were found in 1,876 (71%), 316 (12%), and 319 studies (12%), respectively, and 144 studies (5%) were unclassifiable. Twenty-four of 113 indications (21%) were not used. Innocent murmur and syncope or palpitations with no other indications of cardiovascular disease, a benign family history, and normal electrocardiogram accounted for 75% of indications rated R. Pathologic murmur had the highest yield of abnormal findings (40%). Odds of an abnormal finding in an A or M TTE were 6 times that of R (95% confidence interval [CI]: [2.8 to 12.8]). Abnormal findings were more common in patients <1 year of age than in those >10 years of age (odds ratio: 6.4; 95% CI: 4.7 to 8.7). Age was a significant predictor of an abnormal finding after adjusting for indication and site (p < 0.001). Conclusions Most TTEs ordered in pediatric cardiology clinics were for indications rated A. AUC ratings successfully stratified indications based on the yield of abnormal findings. This study identified differences in the yield of TTE based on patient age and most common indications rated R. These findings should inform quality improvement efforts and future revisions of the AUC document.

AB - Background Recently published appropriate use criteria (AUC) for initial pediatric outpatient transthoracic echocardiography (TTE) have not yet been evaluated for clinical applicability. Objectives This study sought to determine the appropriateness of TTE as currently performed in pediatric cardiology clinics, diagnostic yield of TTE for various AUC indications, and any gaps in the AUC document. Methods Data were prospectively collected from patients undergoing initial outpatient TTE in 6 centers. TTE indications (appropriate [A], may be appropriate [M], or rarely appropriate [R]) and findings (normal, incidental, or abnormal) were recorded. Results Of the 2,655 studies ordered by 102 physicians, indications rated A, M, and R were found in 1,876 (71%), 316 (12%), and 319 studies (12%), respectively, and 144 studies (5%) were unclassifiable. Twenty-four of 113 indications (21%) were not used. Innocent murmur and syncope or palpitations with no other indications of cardiovascular disease, a benign family history, and normal electrocardiogram accounted for 75% of indications rated R. Pathologic murmur had the highest yield of abnormal findings (40%). Odds of an abnormal finding in an A or M TTE were 6 times that of R (95% confidence interval [CI]: [2.8 to 12.8]). Abnormal findings were more common in patients <1 year of age than in those >10 years of age (odds ratio: 6.4; 95% CI: 4.7 to 8.7). Age was a significant predictor of an abnormal finding after adjusting for indication and site (p < 0.001). Conclusions Most TTEs ordered in pediatric cardiology clinics were for indications rated A. AUC ratings successfully stratified indications based on the yield of abnormal findings. This study identified differences in the yield of TTE based on patient age and most common indications rated R. These findings should inform quality improvement efforts and future revisions of the AUC document.

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KW - outpatient

KW - pediatric cardiology

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