Article Text

Download PDFPDF
44 Appropriate use criteria for transthoracic echocardiography: are they relevant outside the united states?
  1. R Kerley,
  2. S O’Flynn
  1. Cork University Hospital, Cork, Ireland


Background 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 centres, inappropriate referral rates as high as 15% have been observed (table 1).

Abstract 44 Figure 1

Rate of in-appropriate referrals

Methods A retrospective analysis of TTE referrals for appropriateness and major abnormality detection was conducted over a two-month period at Cork University Hospital (CUH).

Results 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<0.05) and cardiologist referrals compared to non-cardiologists (13.1 vs 8.0%, p<0.05), 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<0.001) and greater detection rates of new abnormalities (27.6% vs 13.3%, p<0.001).

Conclusion Application of the 2011 AUC yields similar results to those reported from the US. The application of said criteria to our centre could avoid one of every ten scans currently ordered.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.