Does the revised appropriate use criteria for echocardiography represent an improvement over the initial criteria? a comparison between the 2011 and the 2007 appropriateness use criteria for echocardiography

Background: The appropriateness use criteria (AUC) for the performance of transthoracic echocardiography were recently revised. The aims of this study were to evaluate the 2011 AUC for echocardiography for their ability to categorize indications not addressed by the older AUC and to identify trends in ordering unclassified and inappropriate studies when applying the new AUC. Methods: We reviewed 384 consecutive adult transthoracic echocardiographic studies performed at a tertiary care teaching hospital. The appropriateness of each study was determined applying both the 2007 and the 2011 AUC. Results: Among the 384 studies evaluated, 212 (55.2%) were performed in men, 261 (67.9%) were inpatient studies, and 186 (48.4%) were ordered by cardiologists. Compared with the older 2007 AUC, applying the new 2011 AUC demonstrated a lower rate of unclassified studies (5.5% vs 12.5%), higher rates of appropriate (92.2% vs 86.7%) and inappropriate (1.8% vs 0.8%) studies, and no significant change in the rate of uncertain studies (0.5% vs 0.0%). Of the 5.5% of studies that continued to be unclassified despite the application of the more extensive 2011 AUC, common indications included preoperative evaluation for non-transplantation surgery in patients with coronary artery disease, postoperative assessment of thoracic aortic surgery in the absence of any clinical change, and reassessment of ventricular function after revascularization in the absence of acute coronary syndromes. Conclusions: Compared with the 2007 AUC for transthoracic echocardiography, application of the recently revised 2011 criteria leads to a significant decrease in the number of studies that are not classified, demonstrating that the AUC revision was successful in achieving the goal of addressing more clinical indications.