A single‑centre audit of request forms and the 2011 appropriate use criteria for transthoracic echocardiography
Article Sidebar
Main Article Content
Abstract
Background: Transthoracic echocardiography (TTE) is a useful diagnostic tool in cardiology practice. The information provided by the requesting physician is a helpful guide in the interpretation of findings. This study aimed to audit echocardiography request forms (ECFs).
Methods: A 3-year retrospective audit of echocardiography request forms (ERFs) received at a community-based echocardiography centre in Delta State, Nigeria. Delta State University Teaching Hospital Health Research Ethics Committee granted ethical approval to conduct this study. Data extracted from the ERFs were patients’ name, age, sex, address and indication/background clinical information, the name and signature of requesting physician, name of referring hospital and date of the request. Evaluation of the appropriateness of the indications for echocardiography was done using 2011 Revised American College of Cardiology Foundation’s appropriate use criteria (AUC). The corresponding echocardiograms were coded as normal or abnormal reports. Data were anonymised and analysed using the SPSS software version 23.
Results: All the 412 ERFs audited had the names of the patients. The patients’ age, sex and address were missing in 22.6%, 11.4% and 92.5% of the ERFs, respectively. A total of 119 (28.9%) ERFs lacked indication/ clinical information and thus unclassifiable using the 2011 AUC. Of the remaining ERFs, the AUC was appropriate, inappropriate and uncertain in 259 (88.4%), 26 (8.9%) and 8 (2.7%), respectively. Majority of the ERFs with uncertain indications had normal echocardiograms. The echocardiograms of 78% (93/119) of the patients whose ERFs lacked indication/clinical information were abnormal.
Conclusion: In this study, ERFs were inadequately filled. However, majority of the stated indications/clinical information for TTE were classified as appropriate.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The journal grants the right to make small numbers of printed copies for their personal non-commercial use under Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License.
References
1. Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017;70:1-25.
2. Di Carli MF, Kwong RY, Solomon SD. Noninvasive cardiac imaging: Echocardiography, nuclear cardiology, and magnetic resonance/computed tomography imaging. In: Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 20th ed. McGraw-Hill. Available from: https://accessmedicine.mhmedical.com/context.aspx?bookid=2129§ionid=192280465. [Last accessed on 2020 Jul 14].
3. Evangelista A, Flachskampf F, Lancellotti P, Badano L, Aguilar R, Monaghan M, et al. European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr 2008; 9: 438-48.
4. van Heur LM, Baur LH, Tent M, Lodewijks-van der Bolt CL, Streppel M, Winkens RA, et al. Evaluation of an open access echocardiography service in the Netherlands: A mixed methods study of indications, outcomes, patient management and trends. BMC Health Serv Res 2010;10:37.
5. Bhatia RS, Ivers NM, Yin XC, Myers D, Nesbitt GC, Edwards J, et al. Improving the appropriate use of transthoracic echocardiography: The Echo WISELY trial. J Am Coll Cardiol 2017;70:1135-44.
6. SteedsRP, GarbiM, CardimN, KasprzakJD, SadeE, NihoyannopoulosP, et al. EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: A report of literature and current practice review. Eur Heart J Cardiovasc Imaging 2017;18:1191-204.
7. Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate use criteria for echocardiography: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2011;24:229-67.
8. Ballo P, Bandini F, Capecchi I, Chiodi L, Ferro G, Fortini A, et al. Application of 2011 American College of Cardiology Foundation/American Society of Echocardiography appropriateness use criteria in hospitalized patients referred for transthoracic echocardiography in a community setting. J Am Soc Echocardiogr 2012;25:589-98.
9. Al-Kaisey A, Jones E, Nadurata V, Farouque O, De Silva D, Ramchand J. Appropriate use of echocardiography in an Australian regional centre. Intern Med J 2015;45:1128-33.
10. Kerley RN, O’Flynn S. A systemic review of appropriate use criteria for transthoracic echocardiography: Are they relevant outside the United States? Ir J Med Sci 2019;188:89-99.
11. Caruana M, Fenech A, Tilney T, Felice H, Xuereb RG, Aquilina O, et al. Requesting of non-urgent transthoracic echocardiograms. Online J Clin Audits 2010;2:1-9.
12. Umuerri EM, Aigbe FI, Aiwuyo HO, Obasohan AO. Pattern of cardiac diseases and diagnostic utility of transthoracic echocardiography in Delta State University Teaching Hospital, Oghara, Nigeria. Afr J Trop Med Biomed Res 2015;2:20-7.
13. Saidu H, Sani MU, Mijinyawa MS, Yakasai AM. Echocardiographic pattern of heart diseases in a North-Western Nigerian tertiary health institution. Niger J Basic Clin Sci 2015;12:39-44.
14. Uwanuruochi K, Offia E, Ukpabi OJ, Chuku A, Ogah OS. Initial experience with echocardiography at the Federal Medical Centre, Umuahia, Nigeria. Niger J Cardiol 2015;12:13-7.
15. Talle MA, Anjorin CO, Buba F, Bakki B. Spectrum of cardiovascular diseases diagnosed using transthoracic echocardiography: Perspectives from a tertiary hospital in North-Eastern Nigeria. Niger J Cardiol 2016;13:39-45.
16. AjayiEA, Adewuya OA, OhunakinAA, Olaoye OB. Echocardiographic pattern of heart diseases at a Southwest Nigerian private clinic. Sahel Med J 2018;21:153-6.
17. Ogbemudia EJ, Sadoh WE. An assessment of the clinical utility of echocardiography criteria in a Tertiary Health Center. Niger Med J 2015; 56: 268-71.
18. Gurzun MM, Ionescu A. Appropriateness of use criteria for transthoracic echocardiography: Are they relevant outside the USA? Eur Heart J Cardiovasc Imaging 2014;15:450-5.