Clinical InvestigationPediatric EchocardiographyTemporal Trends in Utilization of Transthoracic Echocardiography for Common Outpatient Pediatric Cardiology Diagnoses over the Past 15 Years
Section snippets
Methods
This retrospective study was approved by the Institutional Review Board of Children's Healthcare of Atlanta. Patients ≤18 years old who underwent initial evaluation in an outpatient setting at our pediatric cardiology clinics from January 2000 to December 2014 and were discharged with a final diagnosis of innocent murmur, noncardiac chest pain, benign (vasovagal or neurocardiogenic) syncope, and palpitations were included. This information was obtained from a database maintained by our billing
Results
During the study period 78,787 patients were seen by 50 physicians and discharged with a final diagnosis of innocent murmur, noncardiac chest pain, benign syncope, or palpitations. Fifteen physicians and 3,906 patients seen by these physicians were excluded since they saw fewer than 500 patients during the study period. Of the remaining 74,881 subjects who were analyzed, 36,053 (48.1%) had a TTE. In the randomly selected sample of 100 patients, the final discharge diagnosis matched with that
Discussion
This is the first pediatric study describing temporal trends in utilization of TTE for common outpatient diagnoses for which such testing is known to be low yield. We noted that following the initial growth in the rate of TTE use from 2000 to 2004, there has been a steady decline. This study also identifies some important factors that influenced TTE utilization over the 15-year study period. Interestingly, despite adjusting for these factors, the temporal trends in TTE utilization persisted.
Conclusions
In this large single-center study focused on four common final discharge diagnoses, there was an upward trend in the TTE rate from 2000 until 2004, which was followed by a steady decline over the past decade. Although the initial growth mirrored changes in adult cardiology, the decline in the latter part of the study is in sharp contrast to the trends reported in adult patients, where there remains continued growth in these services. While some important factors influencing the temporal trends
Acknowledgments
We acknowledge the help provided by Meron Kebede, Sibley Heart Canter Cardiology, for data extraction. We also acknowledge the Emory + Children's Pediatric Biostatistics Core for their help with analysis of the data.
References (23)
- et al.
Evaluation of heart murmurs in children: cost-effectiveness and practical implications
J Pediatr
(2002) - et al.
Syncope in children: diagnostic tests have a high cost and low yield
J Pediatr
(2005) - et al.
ACCF proposed method for evaluating the appropriateness of cardiovascular imaging
J Am Coll Cardiol
(2005) - et al.
ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE 2014 appropriate use criteria for initial transthoracic echocardiography in outpatient pediatric cardiology: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Academy of Pediatrics, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography
J Am Coll Cardiol
(2014) - et al.
Pediatric Appropriate Use Criteria Implementation Project: a multicenter outpatient echocardiography quality initiative
J Am Coll Cardiol
(2015) - et al.
Temporal trends in the utilization of echocardiography in Ontario, 2001 to 2009
JACC Cardiovasc Imaging
(2013) - et al.
Evolving trends in the use of echocardiography: a study of Medicare beneficiaries
J Am Coll Cardiol
(2007) - et al.
U.S. Hospital use of echocardiography: insights from the Nationwide Inpatient Sample
J Am Coll Cardiol
(2016) - et al.
Trends in pediatric cardiology referrals, testing, and satisfaction at a Canadian tertiary centre
Can J Cardiol
(2015) - et al.
Effect of release of the first pediatric appropriate use criteria on transthoracic echocardiogram ordering practice
Am J Cardiol
(2016)
Practice variation and resource use in the evaluation of pediatric vasovagal syncope: are pediatric cardiologists over-testing?
Pediatr Cardiol
Cited by (7)
Factors Influencing Temporal Trends in Pediatric Inpatient Imaging Utilization
2020, Journal of the American Society of EchocardiographyCitation Excerpt :One such study showed that underutilization of echocardiography among critically ill adult inpatients was associated with poorer outcomes.10 Resource utilization is also affected by wide variability in clinical practice not only among centers but also among providers within each center.4,17-20 For noncardiac imaging among pediatric patients, the American College of Radiology has 17 appropriateness criteria documents that include guidelines for multimodality imaging use in the evaluation of common clinical scenarios such as appendicitis, walking with a limp, and sinusitis.21
Heart murmur in children less than 2 years-old: looking for a safe and effective referral strategy
2018, Anales de PediatriaFactors Influencing Pediatric Outpatient Transthoracic Echocardiography Utilization Before Appropriate Use Criteria Release: A Multicenter Study
2017, Journal of the American Society of EchocardiographyCitation Excerpt :Previous investigations have focused on appropriateness ratings of ordered TTE but did not include data on TTE that was not ordered, or they focused on a single indication.8,12,13 A recent single-center review reported temporal trends in TTE utilization for common benign discharge diagnoses and factors associated with utilization but did not determine AUC indications.10 In our study, 12% of visits with an indication of either appropriate or rarely appropriate were discordant with TTE ordering.
Pediatric Appropriate Use Criteria for Outpatient Echocardiography: Practice Variations among Pediatric Cardiologists, Noncardiologist Subspecialists, and Primary Care Providers
2017, Journal of the American Society of EchocardiographyAppropriate use of echocardiography for palpitations in paediatric cardiology clinics
2020, Cardiology in the Young