Abstract 18762: Adherence to Appropriate Use Criteria for Transesophageal Echocardiography Use in Suspected Infective Endocarditis
Introduction: AHA appropriate use criteria (AUC) and valvular heart disease guidelines help direct appropriate utilization of transesophageal echocardiography (TEE) in suspected infective endocarditis (IE). A limitation of previous literature examining TEE AUC adherence was underrepresentation of studies performed in suspected IE.
Hypothesis: We hypothesized that TEE was often inappropriately utilized in the evaluation of low pretest probability patients, defined as those without high risk predisposing factors and a low modified duke score following quality TTE.
Methods: Clinical information retrieved from the electronic medical record was used to retrospectively analyze 229 consecutive TEE studies performed in the evaluation of suspected IE between 7/1/2013-12/31/2015 at a large academic center.
Results: Inappropriate TEE use was determined in 14% of studies. All inappropriate studies failed to show TEE evidence of IE. About two thirds (67%) of inappropriate studies were ordered by three groups - Internal Medicine (35%), Family Medicine (16%), and Medical Intensive Care Unit (16%). One third (33%) of all inappropriate studies were performed in evaluation of bacteremia with a microorganism not typically causing IE.
Conclusions: In conclusion, a sizable minority of inappropriate TEE studies were performed in low risk patients. No evidence of IE was found on any of the inappropriate TEEs, thus reinforcing the inappropriate nature of these studies. Three subspecialty groups were responsible for the majority of inappropriate studies. The most common reason for inappropriate TEE use was in evaluation of bacteremia with an atypical IE pathogen.
- Transesophageal echocardiography
- Cardiovascular imaging
- Quality improvement
Author Disclosures: C.M. Bianco: None. A.E. Burch: None. Y.L. Cameron: None. D.S. Grewal: None. S.P. Puneet: None. S.F. Sears: None. R. Nekkanti: None.
- © 2016 by American Heart Association, Inc.