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Published on: July 18, 2014
ACR Appropriateness Criteria® Congenital or Acquired Heart Disease
, Rajesh Krishnamurthy1, Garima Suman2
1Nationwide Children's Hospital, Columbus, Ohio.
Insights
This guide details advanced imaging appropriateness for pediatric heart diseases, including congenital heart defects and coronary artery abnormalities. It aids diagnosis, treatment planning, and complication monitoring in children and adults.
Area of Science:
- Cardiology
- Pediatric Imaging
- Medical Guidelines
Background:
- Pediatric heart disease affects 6-13 per 1,000 live births, encompassing diverse conditions.
- Advanced imaging plays a crucial role throughout the disease spectrum.
- Guidelines are essential for appropriate utilization of these technologies.
Purpose of the Study:
- To outline the appropriateness of advanced imaging for various pediatric heart conditions.
- To cover the full spectrum of disease, from diagnosis to complication detection.
- To provide evidence-based recommendations for clinical practice.
Main Methods:
- Utilized the American College of Radiology Appropriateness Criteria framework.
- Systematic analysis of peer-reviewed medical literature.
- Employed the RAND/UCLA Appropriateness Method for scenario evaluation.
- Incorporated expert opinion where literature was limited.
Main Results:
- Established appropriateness criteria for advanced imaging in conditions like tetralogy of Fallot, transposition of great arteries, and aortopathy.
- Indications span initial diagnosis, treatment planning, monitoring, and complication surveillance.
- Recommendations address the entire natural history of pediatric heart diseases.
Conclusions:
- Advanced imaging is critical for managing a wide array of pediatric heart diseases.
- These evidence-based guidelines support optimal patient care and resource utilization.
- The criteria facilitate informed decision-making for pediatric cardiac imaging.
Abstract:
Pediatric heart disease is a large and diverse field with an overall prevalence estimated at 6 to 13 per 1,000 live births. This document discusses appropriateness of advanced imaging for a broad range of variants. Diseases covered include tetralogy of Fallot, transposition of great arteries, congenital or acquired pediatric coronary artery abnormality, single ventricle, aortopathy, anomalous pulmonary venous return, aortopathy and aortic coarctation, with indications for advanced imaging spanning the entire natural history of the disease in children and adults, including initial diagnosis, treatment planning, treatment monitoring, and early detection of complications. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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