Abstract 15798: Yield of Echocardiograms Using Appropriate Use Criteria in an Outpatient Pediatric Cardiology Clinic at an Urban Community Hospital
Introduction: Appropriate Use Criteria (AUC) were published in 2014 to help clinicians determine the need for echocardiograms in an outpatient setting. One hundred thirteen indications were identified based on common clinical scenarios. A separate, independent rating panel evaluated each indication using a scoring scale of 1 to 9, thereby designating each indication as “Appropriate” (A, median score 7 to 9), “May Be Appropriate” (M, median score 4 to 6), or “Rarely Appropriate” (R, median score 1 to 3). Fifty-three indications were identified as Appropriate, 28 as May Be Appropriate, and 32 as Rarely Appropriate.
Objectives: 1. To determine the yield of echo for indications that meet three different sets of criteria, before the publication of AUC; 2. To identify the predictors and reasons of an abnormal echo among the patients falling into 3 different criteria (A, M, R).
Methods: This was a descriptive chart review of 581 patients who had their first echocardiogram for various indications during the years 2011-2014. Results were analyzed by Pearson’s chi-square test.
Results: The overall yield was 10%. Female gender (23.1%) had the higher overall yield compared to male (8.8%) (p=0.002). Yield for the A criteria was 15.4%, for M criteria was 8.5%, and for R criteria was 5.4% (p=0.001). Patients ages zero-3 months (67.6%) and 4-11 months (66.7%) had the highest yields in the A criteria group with a yield of 1.5% in the 12-18 years age group (p<0.0001). Murmur had highest yield of 47.5% in the A group. Chest pain, cyanosis and hypertension had 0% yield. In the M criteria group, 0-3 months (100%) had the highest yield among all the age groups; murmur (33.3%) had the highest yield among all the symptoms. In the R criteria group, 0-3 months age group (17.8%) and murmur (8.3%) had the highest yields.
Conclusions: Yield was higher in patients with indications meeting appropriate criteria per AUC, especially among the younger age groups. AUC use in the future, when ordering echocardiograms by pediatric cardiologists, may contribute to a higher yield in the outpatient setting.
Author Disclosures: R. Billa: None. L. Zeinali: None. S. Szpunar: None. P. Anne: None.
- © 2016 by American Heart Association, Inc.