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Development and validation of a screening tool for the identification of inappropriate transthoracic echocardiograms


Fonseca, R and Pathan, F and Marwick, TH, Development and validation of a screening tool for the identification of inappropriate transthoracic echocardiograms, BMJ Open, 6, (10) Article e012702. ISSN 2044-6055 (2016) [Refereed Article]


Copyright Statement

Copyright 2016 BMJ Licensed under Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license

DOI: doi:10.1136/bmjopen-2016-012702


OBJECTIVE: We sought whether simple clinical markers could be used in a questionnaire for recognition of inappropriate (or rarely appropriate, RA) tests at point-of-service. Most applications of appropriateness criteria (AC) for transthoracic echocardiogram (TTE) have been at the point of order, but a simple means of identifying RA tests in an audit process would be of value.

DESIGN, SETTING AND PARTICIPANTS: The study was performed in 2 major hospitals in Tasmania. 2 reviewers created a questionnaire based on 4 questions most commonly associated with RA (suspected endocarditis with no positive blood cultures or new murmur, lack of cardiovascular symptoms or no change in clinical status or cardiac examination, routine surveillance and previous TTE within a year) in a derivation cohort of 814 patients. This was prospectively applied to 499 TTEs to calculate sensitivity and specificity for prediction of RA, and validated in the external group (n=880).

RESULTS: Of 499 prospective TTEs, the questionnaire selected 18% requests as being potentially RA. As 7.4% were actually RA (κ 89%), the sensitivity and specificity of the questionnaire were 84% and 87%, respectively. In the external validation cohort, the model found 11% requests needed to be screened for appropriateness with a sensitivity and specificity of 80% and 95%.

CONCLUSIONS: A questionnaire based on 4 questions detects a high proportion of RA TTE, and could be used for audit.

Item Details

Item Type:Refereed Article
Keywords:appropriate use, appropriate use echocardiography
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Fonseca, R (Mr Ricardo Fonseca Diaz)
UTAS Author:Pathan, F (Dr Faraz Pathan)
UTAS Author:Marwick, TH (Professor Tom Marwick)
ID Code:112572
Year Published:2016
Web of Science® Times Cited:6
Deposited By:Menzies Institute for Medical Research
Deposited On:2016-11-16
Last Modified:2022-08-30
Downloads:163 View Download Statistics

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