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Cardiovascular medicine
Research
Development and validation of a screening tool for the identification of inappropriate transthoracic echocardiograms
  1. Ricardo Fonseca1,
  2. Faraz Pathan1,
  3. Thomas H Marwick2
  1. 1Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
  2. 2Baker IDI Heart and Diabetes Institute, Melbourne, Tasmania, Australia
  1. Correspondence to Dr Thomas H Marwick; tom.marwick{at}bakeridi.edu.au

Abstract

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.

  • appropriate use
  • appropriate use echocardiography

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-012702

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    Footnotes

    • RF and FP should be regarded as joint first authors.

    • Contributors THM and RF designed the study. RF and FP were responsible for data collection and data analysis under supervision of THM. RF and FP prepared the manuscript draft. THM edited and approved the final manuscript. All the authors had full access to all of the data (including statistical reports and tables) in the study.

    • Funding RF is supported by a scholarship from the Farrell Foundation, Hobart, Australia.

    • Competing interests None declared.

    • Ethics approval This study was approved by the Tasmanian Human Research Ethics Committee, reference number: H0014017.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.