Title : Evaluation of echocardiography appropriateness in acute medical unit: A retrospective cohort study
Abstract:
Background: Echocardiography is a widely used diagnostic tool in Acute Medical Units (AMUs), but its inappropriate use can strain healthcare resources. The Appropriate Use Criteria (AUC) for echocardiography, developed by the American College of Cardiology (ACC) and the American Society of Echocardiography (ASE), provides evidence-based guidance to optimize utilization.
Methods: Our institution’s clinical audit office approved the study (ref 6; dated 18/09/2024). We conducted a retrospective review of 93 consecutive patients who underwent bedside echocardiography in an AMU over five months. According to AUC guidelines, indications were classified as appropriate, inappropriate, or uncertain. Demographic data, clinical indications, echocardiographic findings, and patient outcomes were analyzed.
Results: The majority of echocardiograms (87.1%, n=81) were deemed appropriate, while 12.9% (n=12) were inappropriate (p<0.001). Patients with appropriate studies were significantly older (median age 72 vs. 54 years, p<0.001). Common indications included syncope/presyncope (21.5%), dyspnea (15.1%), and chest pain (12.9%). Significant findings were detected in 36.6% of studies, with 91.2% occurring in appropriate requests. Worthly, 8.8% of inappropriate studies still revealed clinically significant abnormalities. Follow-up departmental echocardiograms were required in 10.75% of cases, primarily for appropriate indications. Patients with inappropriate studies had longer post-echocardiography hospital stays (median 2.0 vs. 0.0 days, p=0.01).
Conclusion: Whereas most echocardiography requests in our AMU adhered to AUC guidelines, 12.9% were inappropriate, potentially contributing to resource wastefulness. Nevertheless, detecting significant findings in some inappropriate studies suggests clinical judgment remains essential. Implementation of AUC-guided request forms and clinician education may further optimize utilization.
Keywords: Echocardiography, Appropriate Use Criteria, Acute Medical Unit, Resource Utilization.
