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[Appropriateness of requests of echo-color-Doppler tests]
Nello Zanatta1, Aniello Cioffi, Enrico Brocco
1Sezione di Angiologia, Unità Operativa di Medicina, Ospedale Civile, Vittorio Veneto (Treviso), Azienda USL No. 7 della Regione Veneto. nzanatta@libero.it
Insights
Color-Doppler ultrasonography requests are frequently inappropriate, especially for carotid-vertebral arteries and when clinical information is missing. Improving clinical evaluation is key to reducing unnecessary vascular imaging and improving diagnostic accuracy.
Area of Science:
- Vascular Medicine
- Diagnostic Imaging
- Medical Technology
Context:
- Technological advancements in ultrasound have increased demand for diagnostic imaging.
- Color-Doppler sonography is widely used for diagnosing vascular diseases.
- There is a growing concern regarding the appropriate utilization of these imaging modalities.
Purpose:
- To evaluate the appropriate use of color-Doppler sonography requests based on published guidelines.
- To identify factors contributing to inappropriate use of vascular ultrasound examinations.
- To assess the diagnostic yield of color-Doppler sonography in a real-world clinical setting.
Summary:
- A study analyzed 986 color-Doppler sonography requests over three months.
- 60.2% of requests were deemed inappropriate, with higher rates for carotid-vertebral arteries (67.9%) and urgent exams (21.9%).
- Lack of clinical reason in requests correlated with 70% inappropriate use; 52.9% of all exams revealed no vascular pathology.
Impact:
- Findings highlight a significant overuse of color-Doppler sonography, suggesting poor clinical assessment of patients with suspected vascular conditions.
- The high rate of inappropriate use and normal results indicates a need for better clinical integration and guideline adherence.
- Emphasizing clinical evaluation can optimize resource allocation, reduce unnecessary procedures, and improve the interpretation of vascular ultrasound data.
Abstract:
Technological development of ultrasound has allowed diagnosis of diseases that one would be able to see later. These easy and harmless examinations have produced an increasing in demand not always justified, as one could think to reach simply a shining diagnosis. The authors evaluated the appropriate use of each color-doppler sonography request in agreement with published guidelines. Nine hundred eighty six requests were examined in three months: 60.2% of them were not appropriate. Carotid-vertebral arteries were the group with higher inappropriate use (67.9%) and also the urgent exams have 21.9% of inappropriate use. When clinical reason was missing in the request, the inappropriate use reached 70%. The 52.9% of examinations have not revealed any vascular pathology and among appropriate exams the 31.7% was disease free. Although angiology clinical guidelines have been recently published in Italy, the data suggest a poor clinical valuation of suspected vascular patient (70% of not appropriate examination when clinical problem was lacking); this may be the answer for both the enormous color-doppler requests, high inappropriate use and normal results. Authors think that a way to lower this high grade of color-doppler exams may be to take in appropriate consideration clinical approach, fact that also permit a correct interpretation of ultrasonographic data.