Consensus-Based Development of a Pediatric Echocardiography Complexity Score: Design, Rationale, and Results of a...

Area of Science:

• Pediatric Cardiology
• Medical Imaging
• Health Services Research

Background:

• Congenital heart disease (CHD) complexity is traditionally assessed by surgical difficulty, diagnosis, and outcomes.
• Existing methods lack a standardized approach for evaluating echocardiography complexity.
• A pediatric echocardiography complexity (PEC) score was previously developed and requires refinement and validation.

Purpose of the Study:

• To refine and validate a pediatric echocardiography complexity (PEC) score.
• To assess the PEC score's ability to predict study duration and its applicability across diverse clinical settings.
• To establish a tool for correlating echocardiography complexity with diagnostic errors and resource allocation.

Main Methods:

• A panel from 12 centers refined a single-institution PEC score, incorporating study modifiers.
• Data from 174 consecutive inpatient and outpatient echocardiograms were collected using the PEC scoring tool.
• Univariate and multivariate analyses identified predictors of longer study duration, controlling for center variation.

Main Results:

• 68.9% of analyzed echocardiograms were for patients with CHD.
• Higher PEC scores (4 or 5) were independently associated with longer study durations.
• Factors like younger age, initial/preoperative studies, and trainee involvement also predicted longer study times.

Conclusions:

• The refined PEC scoring tool is feasible and applicable across various clinical settings.
• The PEC score can be utilized for correlating complexity with diagnostic errors and optimizing resource allocation.
• The tool aids in assessing physician and sonographer effort in pediatric echocardiography performance, interpretation, and training.