Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói.
Arq Bras Cardiol. 2012 Oct;99(4):952-4. doi: 10.1590/s0066-782x2012001300012.
Guidelines from medical societies suggest recommendations for the appropriate request of tests. In 2009, the Brazilian Society of Cardiology (BSC) published new guidelines for transthoracic echocardiography (TTE) request.
To evaluate the prevalence of Class III requests for TTE, as defined by the BSC Guidelines and analyze these requests profile comparing a public university hospital (PUH) with a private cardiology hospital (PCH).
We prospectively evaluated 779 consecutive outpatient TTE requests: 391 from the PCH and 388 from the PUH between December 2009 and May 2010. The indications studied were classified accordingly to the BSC guidelines. Request distribution was compared by Chi-square test. Statistical significance was set at p < 0.05.
Of the 779 requests, 61 (7.8%) were considered Class III. Of these 14 were from the public and 47 from the private hospital. The distribution of requests was statistically different between institutions (p < 0.001). Check-up in asymptomatic patients was the main inadequate indication, with 37 cases (33 in the private institution- 89.18%), followed by evaluation after angioplasty in 9 cases (8 in the private institution - 88.88%); ventricular function monitoring in patients with stable heart failure in 6 cases (4 in the public institution - 66.66%), post-bypass surgery in 5 cases (4 in the private institution- 80%), and evaluation of nonspecific electrocardiographic abnormalities in 4 cases (4 in the public institution - 100%).
Asymptomatic patients' assessment was the main cause of inadequate TTE requests, which differs between institutions: routine check-up in the private and heart failure in the public hospital.
医学协会的指南建议对适当的检查请求提出建议。2009 年，巴西心脏病学会（BSC）发布了新的经胸超声心动图（TTE）请求指南。
评估 BSC 指南定义的 TTE 类 III 请求的流行率，并分析这些请求的特征，比较一家公立医院（PUH）和一家私立心脏病医院（PCH）。
我们前瞻性评估了 779 例连续门诊 TTE 请求：2009 年 12 月至 2010 年 5 月，PCH 391 例，PUH 388 例。研究的适应症根据 BSC 指南进行分类。通过卡方检验比较请求分布。统计学意义设为 p<0.05。
779 份请求中，61 份（7.8%）被认为是类 III 。其中 14 份来自公立，47 份来自私立医院。机构间请求分布存在统计学差异（p<0.001）。无症状患者的检查是主要的不适当适应症，有 37 例（私立医院 33 例-89.18%），其次是经皮冠状动脉介入治疗后评估 9 例（私立医院 8 例-88.88%）；稳定心力衰竭患者心室功能监测 6 例（公立 4 例-66.66%），旁路手术后 5 例（私立 4 例-80%），非特异性心电图异常评估 4 例（公立 4 例-100%）。
无症状患者评估是 TTE 请求不适当的主要原因，不同机构之间存在差异：私立医院常规检查，公立医院心力衰竭。
