Dalal Nupur N, Dzelebdzic Sanja, Frank Lowell H, Clauss Sarah B, Mitchell Stephanie J, Aljohani Othman A, Bradley-Hewitt Tyler, Harahsheh Ashraf S
1 Children's National Health System, Washington, DC, USA.
2 The George Washington University, Washington, DC, USA.
Clin Pediatr (Phila). 2018 Oct;57(12):1436-1441. doi: 10.1177/0009922818787280. Epub 2018 Jul 11.
We conducted a retrospective study to identify electrocardiogram (ECG) and echocardiogram utilization among patients presenting for a follow-up cardiology evaluation with innocent heart murmur between 2012 and 2014. The 2014 echocardiogram Appropriate Use Criteria was applied. We observed high rates of ordering ECGs and echocardiograms on follow-up visits (79% and 36%); only 1 patient had an appropriate indication for echocardiogram while the rest had rarely appropriate indication. Having had an ECG done did not affect echocardiogram ordering behavior. Older patient age was the only factor associated with a higher likelihood for ordering echocardiograms on follow-up visit (odds ratio = 1.016, P = .021). In this small sample study, we noticed high rates of test utilization and low-probability utilization of echocardiogram in the recurrent evaluation of children with innocent heart murmur. A larger, multicenter prospective study to investigate patterns and drivers of test utilization in children with innocent heart murmur presenting for a follow-up cardiology visit is needed.
我们进行了一项回顾性研究，以确定2012年至2014年间因单纯性心脏杂音前来进行心脏科随访评估的患者的心电图（ECG）和超声心动图使用情况。应用了2014年超声心动图合理使用标准。我们观察到随访就诊时心电图和超声心动图的开具率很高（分别为79%和36%）；只有1例患者有超声心动图的合适指征，其余患者几乎没有合适指征。做过心电图并不影响超声心动图的开具行为。年龄较大是随访就诊时开具超声心动图可能性较高的唯一相关因素（比值比=1.016，P=0.021）。在这项小样本研究中，我们注意到在单纯性心脏杂音儿童的反复评估中，检查使用率很高，而超声心动图的低概率使用率很高。需要进行一项更大规模的多中心前瞻性研究，以调查因单纯性心脏杂音前来进行心脏科随访的儿童的检查使用模式和驱动因素。
