Appropriateness criteria are an imprecise measure for repeat echocardiograms

Area of Science:

• Cardiology
• Medical Imaging
• Health Services Research

Background:

• Echocardiogram appropriateness criteria exist but their efficacy for repeat studies is unknown.
• Previous research indicates most initial transthoracic echocardiograms meet guidelines.
• This study addresses the gap in understanding criteria for repeat echocardiograms.

Purpose of the Study:

• To prospectively evaluate the accuracy of current appropriateness criteria for repeat echocardiograms.
• To assess the justification and yield of repeat echocardiographic studies in hospitalized patients.

Main Methods:

• Prospective assessment of consecutive echocardiograms over 30 days.
• Recorded ordering clinician specialty and training level.
• Documented clinical status changes and echocardiographic findings for repeat studies.

Main Results:

• Of 574 echocardiograms, 143 were repeats in 104 patients.
• Appropriateness was 84.6% for initial studies vs. 73.4% for repeats (P=0.005).
• 40% of repeat echocardiograms lacked clear justification; 52% revealed new findings.

Conclusions:

• Repeat echocardiograms are more frequently inappropriate than initial studies.
• A substantial number of repeat echocardiograms lack justification and yield limited new information.
• Current appropriateness criteria may require revision, especially for repeat cardiac imaging.