Ward R Parker, Mansour Ibrahim N, Lemieux Nicole, Gera Nitin, Mehta Rupa, Lang Roberto M
Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
JACC Cardiovasc Imaging. 2008 Sep;1(5):663-71. doi: 10.1016/j.jcmg.2008.07.004.
We sought to prospectively evaluate the clinical application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria (AC) for transthoracic echocardiography in a single-center university hospital. Indications for transthoracic echocardiograms (TTE) were prospectively determined for consecutive studies by 2 reviewers and categorized, according to the AC for TTE, as appropriate (A) or inappropriate (I). The overall level of agreement in characterizing appropriateness between reviewers was high (kappa = 0.83). Among the 1,553 studies for which a primary indication was determined, 89% were covered in the AC for TTE. Of these studies, 89% were A, and 11% were I. New important TTE abnormalities were more common on A compared with I studies (40% vs. 17%, p < 0.001), and noncardiac specialists more frequently ordered I studies (13% vs. 9%, p = 0.04). In conclusion, the AC for TTE encompasses the majority of clinical indications for TTE and appears to reasonably stratify TTE ordering. However, revisions will be needed to fully capture and stratify appropriate clinical practice.
我们试图在一家单中心大学医院中，对美国心脏病学会基金会/美国超声心动图学会经胸超声心动图适用标准（AC）的临床应用进行前瞻性评估。由两名审阅者对连续研究的经胸超声心动图（TTE）指征进行前瞻性确定，并根据TTE的AC将其分类为适当（A）或不适当（I）。审阅者之间在确定适用性方面的总体一致性水平很高（kappa = 0.83）。在确定了主要指征的1553项研究中，89%涵盖在TTE的AC中。在这些研究中，89%为A类，11%为I类。与I类研究相比，A类研究中出现新的重要TTE异常更为常见（40%对17%，p < 0.001），非心脏专科医生更频繁地开出I类研究（13%对9%，p = 0.04）。总之，TTE的AC涵盖了TTE的大多数临床指征，并且似乎能合理地对TTE检查申请进行分层。然而，需要进行修订以全面涵盖并分层适当的临床实践。
