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Should pediatric echocardiography be performed in adult laboratories?
1Department of Pediatric Cardiology, Indiana University Medical Center, Indianapolis, Indiana 46202-5225, USA.
Insights
Pediatric echocardiography in adult labs often lacks technical adequacy and correct interpretation, leading to repeat studies. Initial referral to pediatric cardiology centers could spare many children unnecessary echocardiograms.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Healthcare Management
Background:
- Referral patterns for pediatric cardiac care are evolving.
- The efficacy of pediatric echocardiography performed in adult laboratories requires evaluation.
Purpose of the Study:
- To determine the effectiveness and value of pediatric echocardiography conducted in adult laboratory settings.
- To assess the technical quality and interpretative accuracy of these studies.
Main Methods:
- A retrospective review of 100 pediatric patients (1 month to 18 years) previously evaluated by echocardiography in adult laboratories.
- Correlation of outside echocardiogram findings with final diagnoses at a pediatric institution.
Main Results:
- 32% of studies were technically inadequate, and 32% had interpretation or communication errors.
- Repeat echocardiography was needed for 38% of patients.
- An estimated 25-30% of patients could have avoided echocardiography with initial referral to a specialized center.
Conclusions:
- Over half of pediatric echocardiograms in adult labs were adequate, but significant issues with quality and interpretation persist.
- Many pediatric patients undergo repeat echocardiography due to initial suboptimal evaluations.
- Directing pediatric patients to specialized pediatric cardiology centers initially can improve diagnostic accuracy and reduce unnecessary procedures.
Objectives:
Current health care management has resulted in a change in referral patterns. The present study was undertaken to define the efficacy and value of pediatric echocardiography performed and interpreted in adult laboratories.
Methods:
We reviewed the findings in 100 consecutive pediatric patients 1 month to 18 years of age referred for possible heart disease and evaluated previously by echocardiography performed in an adult laboratory. Technical adequacy and interpretation of the echocardiogram at the outside facility was correlated with our final diagnosis.
Results:
Of the studies, 32 (32%) were performed in hospital laboratories, and 68 (68%) in physician offices. A total of 52 (52%) of the 100 patients arrived with an outside diagnosis in agreement with our final diagnosis. Technical difficulties were reported in 14 (14%) studies by the original laboratory; we felt that 32 (32%) studies were inadequate. Interpretation or communication between the outside echocardiography laboratory, primary care physicians, and patients' family was erroneous in 32 (32%) cases. Repeat echocardiography was necessary in 38 (38%) patients (6 because of planned surgery). If initial referral had been to our own institution, 25 to 30 patients would not have undergone echocardiography.
Conclusions:
Slightly more than half of echocardiography studies performed in pediatric patients in adult laboratories were technically adequate and interpreted correctly with proper physician-family communication. Many patients require repeat studies on further referral. A significant number would be spared echocardiography if they were sent to a pediatric cardiology center initially.