Abstract 18843: Evaluating Appropriate Use of Pediatric Echocardiogram for Chest Pain in Outpatient Clinics
Introduction: Echocardiography is often used in the evaluation of pediatric chest pain but incidence of uncovered cardiac pathology is low. In 2014, the American College of Cardiology published appropriate use criteria (AUC) for echocardiography in evaluating pediatric chest pain. We sought to evaluate the frequency, diagnostic yield and cost associated with echoes meeting “Rarely Appropriate” criteria.
Methods: Retrospective, single-institution study of all patients 18 years or less with an initial evaluation for chest pain by a pediatric cardiologist (2014-2015). We categorized patients by echo appropriateness based on the AUC. We used multivariable logistic regression to determine factors associated with use of a “Rarely Appropriate” echo. Excess cost was calculated by direct cost estimates for studies and follow-up visits associated with a “Rarely Appropriate” echo.
Results: The cohort included 539 patients, median age 13 years (range 3-18) and 51% female. Retrospective application of the AUC and patient outcomes are summarized in the Figure. Echoes were performed in 71% (380/539) of patients overall and in 36% (60/167) of patients meeting “Rarely Appropriate” criteria. Abnormal echo findings were present in 5% (19/380) and incidental findings in 3% (10/380) overall. There were no abnormal findings (0/60) in the “Rarely Appropriate” subgroup. Provider use of echo in “Rarely Appropriate” patients varied widely from 0-75% across 15 providers (p=0.004). In multivariable analysis, controlling for provider ordering practice by fixed-effect regression, there was no significant association between race, ethnicity, age, sex, or payer status and performance of a “Rarely Appropriate” echo. “Rarely Appropriate” echoes resulted in $280,200 in excess costs ($4,670/patient).
Conclusions: Echo use in patients meeting “Rarely Appropriate” criteria is of little diagnostic utility and contributes to additional cost to the patient and healthcare system.
Author Disclosures: R. Chamberlain: None. J. Pelletier: None. S. Blanchard: None. C.P. Hornik: Employment; Significant; Receives salary support for research from the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR001117). K. Hill: None. M.J. Campbell: None.
- © 2016 by American Heart Association, Inc.