Kerley Robert N, Thornton Kenneth P, Kelly Raymond M, O'Flynn Siun
School of Medicine, University College Cork, Cork, Ireland.
Echocardiography. 2018 Jan;35(1):17-23. doi: 10.1111/echo.13730. Epub 2017 Nov 21.
There is a growing interest in appropriate use criteria (AUC) for cardiovascular imaging referrals in Europe. These criteria, developed by American subspecialty societies, have been in use since 2007 and show a temporal reduction in inappropriate transthoracic echocardiogram (TTE) requests. When applied to European centers, inappropriate referral rates as high as 15% have been observed.
A retrospective analysis of TTE referrals for appropriateness and major abnormality detection was conducted over a two-month period at Cork University Hospital (CUH).
Overall, 1277 requests were assessed, of which 97.7% were classifiable. Of the 1235 classifiable studies, 1049 (84.9%) were appropriate, 135 (10.9%) were inappropriate, and 51 (4.1%) were uncertain. Main indications were the evaluation of cardiac structure and function (496, 40.2%), hypertension, heart failure or cardiomyopathy (349, 28.3%), and valvular function (228, 18.5%). Inappropriate referral rates were significantly higher for outpatients compared to inpatients (13.8% vs 7.1%, P < .05) and cardiologist referrals compared to noncardiologists (13.1 vs 8.0%, P < .05), while one in three requests for the evaluation of valvular function (32.5%) were inappropriate. Compared to inappropriate studies, appropriate and uncertain scans had a greater prevalence of ≥1 major abnormalities (33.6% vs 19.3%, P < .001) and greater detection rates of new abnormalities (27.6% vs 13.3%, P < .001).
Application of the 2011 AUC yields similar results to those reported from the US. The application of said criteria to our center could avoid one of every ten scans currently ordered.
在欧洲，人们对心血管影像检查转诊的合理使用标准（AUC）的兴趣与日俱增。这些由美国亚专业学会制定的标准自2007年起开始使用，显示出经胸超声心动图（TTE）不适当检查请求的数量随时间有所减少。当应用于欧洲的医疗中心时，观察到不适当转诊率高达15%。
在科克大学医院（CUH）对TTE转诊的适宜性和主要异常检测进行了为期两个月的回顾性分析。
总体而言，共评估了1277份检查请求，其中97.7%可分类。在1235份可分类的检查中，1049份（84.9%）是适当的，135份（10.9%）是不适当的，51份（4.1%）不确定。主要指征为评估心脏结构和功能（496例，40.2%）、高血压、心力衰竭或心肌病（349例，28.3%）以及瓣膜功能（228例，18.5%）。与住院患者相比，门诊患者的不适当转诊率显著更高（13.8%对7.1%，P <.05）；与非心脏病专家的转诊相比，心脏病专家的转诊不适当率更高（13.1对8.0%，P <.05），而三分之一的瓣膜功能评估请求（32.5%）是不适当的。与不适当的检查相比，适当和不确定的扫描中≥1项主要异常的患病率更高（33.6%对19.3%，P <.001），新异常的检测率也更高（27.6%对13.3%，P <.001）。
应用2011年的AUC得出的结果与美国报告的结果相似。将上述标准应用于我们的中心可以避免目前所开具的每十次扫描中的一次。
