Department of Medicine, Mayo Clinic Foundation, Rochester, Minnesota 55905, USA.
J Am Soc Echocardiogr. 2010 Mar;23(3):267-74. doi: 10.1016/j.echo.2009.11.005. Epub 2010 Jan 18.
The authors examined the feasibility of application of the American College of Cardiology Foundation's appropriateness criteria for transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) at a large tertiary care practice.
Indications for consecutive TTE and TEE were determined by chart review and classified according to the guidelines as appropriate, inappropriate, or uncertain or, for situations not addressed in the document, nonclassifiable.
Of the 529 studies reviewed, 469 were appropriate, 23 inappropriate, 1 uncertain, and 36 nonclassifiable. Inappropriate and nonclassifiable studies were more commonly TTE than TEE (P<.001). Inappropriate studies were more common in outpatients than inpatients (P<.001). Nonclassifiable cases included assessment after radiofrequency ablation (33.3%) and preoperative evaluation (8.3%). Disagreement between observers in selection of the criterion was present in 30.8%.
Although the study was conducted retrospectively, only 4.7% of classifiable studies were inappropriate. The reproducibility of classification was moderate, and 6.8% of studies were not classifiable. Areas for improvement of the criteria were identified.
作者研究了美国心脏病学院基金会（ACCF）经食管超声心动图（TEE）和经胸超声心动图（TTE）应用适宜性标准在大型三级保健实践中的应用可行性。
通过病历回顾确定连续 TTE 和 TEE 的适应证，并根据指南将其分类为适宜、不适宜或不确定，对于未在文件中涉及的情况，则无法分类。
在审查的 529 项研究中，469 项为适宜，23 项为不适宜，1 项为不确定，36 项为无法分类。不适宜和无法分类的研究更常见于 TTE 而非 TEE（P<.001）。门诊患者中不适宜的研究比住院患者更常见（P<.001）。无法分类的情况包括射频消融（33.3%）和术前评估（8.3%）后评估。在选择标准时观察者之间存在 30.8%的分歧。
尽管该研究是回顾性进行的，但只有 4.7%的可分类研究为不适宜。分类的可重复性为中等，6.8%的研究无法分类。确定了需要改进标准的领域。
