Effect of Release of the First Pediatric Appropriate Use Criteria on Transthoracic Echocardiogram Ordering Practice

Area of Science:

• Pediatric Cardiology
• Medical Imaging Utilization

Background:

• Appropriate Use Criteria (AUC) for initial outpatient pediatric transthoracic echocardiography (TTE) were recently published.
• Understanding the impact of these guidelines on clinical practice is crucial for optimizing healthcare resource allocation.

Purpose of the Study:

• To evaluate the effect of publishing pediatric AUC on the ordering patterns of initial outpatient TTE by pediatric cardiologists.
• To assess changes in the appropriateness of TTE indications before and after AUC implementation.

Main Methods:

• Prospective data collection from 6 centers on initial outpatient TTE orders before (Phase I) and after (Phase II) AUC publication.
• Site investigators assessed TTE indications and categorized appropriateness as "appropriate" (A), "may be appropriate" (M), "rarely appropriate" (R), or "unclassifiable."
• Analysis of 4,562 TTEs ordered by 103 physicians across both phases.

Main Results:

• No statistically significant overall change in the proportion of A, M, or unclassifiable TTEs was observed.
• A statistically significant decrease in "rarely appropriate" (R) TTEs was noted, from 12.0% to 9.6% (p=0.01).
• Significant variability in the percentage of R studies was found among centers (4.9% to 34.8%), with mixed changes in appropriateness ratings at individual sites.

Conclusions:

• The initial pediatric AUC document had a limited impact on physician TTE ordering behavior, evidenced by a small reduction in R indications.
• Substantial variability in TTE appropriateness across different centers highlights a need for targeted educational interventions.
• Active educational strategies are necessary to significantly enhance the appropriate use of pediatric TTE in outpatient settings.