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Recurrent Cardiology Evaluation for Innocent Heart Murmur: Echocardiogram Utilization
Nupur N Dalal1,2, Sanja Dzelebdzic3, Lowell H Frank1,2
11 Children's National Health System, Washington, DC, USA.
Clinical Pediatrics
|July 12, 2018
Summary
Electrocardiogram (ECG) and echocardiogram use is high in follow-up visits for children with innocent heart murmurs. Most echocardiograms lacked appropriate indications, suggesting overuse in routine pediatric cardiology evaluations.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging Utilization
- Clinical Decision Making
Background:
- Innocent heart murmurs are common in children.
- Follow-up evaluations are standard practice.
- Appropriate use criteria for cardiac imaging exist.
Purpose of the Study:
- To assess electrocardiogram (ECG) and echocardiogram utilization in follow-up visits for children with innocent heart murmurs.
- To evaluate the appropriateness of echocardiogram ordering based on 2014 criteria.
Main Methods:
- Retrospective study design.
- Analysis of patient data from 2012-2014.
- Application of the 2014 echocardiogram Appropriate Use Criteria.
Main Results:
- High rates of ECG (79%) and echocardiogram (36%) ordering were observed.
- Only 1 patient met criteria for an appropriate echocardiogram.
- Older patient age was linked to increased echocardiogram likelihood (OR=1.016, P=.021).
Conclusions:
- Significant overuse of echocardiograms in routine follow-up for innocent heart murmurs.
- ECG use did not influence echocardiogram ordering.
- Further multicenter studies are needed to explore utilization drivers.
Keywords:
innocent murmuroutpatient carepediatric cardiologyresource utilizationsubspecialty referralMore Related Videos
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