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Appropriate use of echocardiography for palpitations in paediatric cardiology clinics

Published online by Cambridge University Press:  07 October 2020

Saloni Sheth Open the ORCID record for Saloni Sheth [Opens in a new window] ,
Munes Fares ,
Sandra Kikano ,
Christopher Snyder ,
Andrew Dodgen  and
Carolyn M. Wilhelm
Saloni Sheth*
Affiliation:
Department of Paediatrics, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
Munes Fares
Affiliation:
Department of Paediatric Cardiology, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
Sandra Kikano
Affiliation:
Department of Paediatrics, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
Christopher Snyder
Affiliation:
Department of Paediatric Cardiology, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
Andrew Dodgen
Affiliation:
Department of Paediatric Cardiology, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA Department of Paediatric Cardiology, Children’s Healthcare of Atlanta, Columbus, GA, USA
Carolyn M. Wilhelm
Affiliation:
Department of Paediatric Cardiology, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
*
Author for correspondence: Saloni Sheth, MD, 11100 Euclid Ave, RB&C Room 838, Mail stop 6002, Cleveland, OH44106, USA. Tel: +1 216 844 1000; Fax: +216-844-7166. E-mail: Saloni.Sheth@uhhospitals.org
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Abstract

Objectives:

Identify diagnostic yield and frequency of echocardiograms for palpitation-related indications at outpatient paediatric cardiology clinics in relation to the 2014 ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE appropriate use criteria for Initial Transthoracic Echocardiography in Outpatient Paediatric Cardiology.

Study design:

A single-centre, retrospective study of children presenting for evaluation of a chief complaint of palpitations to outpatient paediatric cardiology clinics from 2015 to 2017. Palpitations were defined as an unpleasant sensation of rapid, irregular, and/or forceful beating of the heart. Indications for echocardiogram in patients were retrospectively classified based on the appropriate use criteria as “appropriate,” “may be appropriate,” or “rarely appropriate.” The incidence of abnormal and incidental echocardiographic findings for each category was determined.

Results:

A total of 286 patients presented with palpitations, with 128 (52% female) meeting inclusion criteria. Exclusion criteria included patients with additional cardiac complaints, prior echocardiogram, or history of congenital heart disease. Echocardiograms were performed on 36 (28%) patients. The appropriate use criteria were retrospectively applied, and indications for their performance were classified as “appropriate” (n = 4), “may be appropriate” (n = 17), or “rarely appropriate” (n = 15). Minor echocardiographic abnormalities were present in 22% (n = 8) of echocardiograms obtained for all appropriate use criteria classifications. No moderate or severe echocardiographic abnormalities were found. Incidental findings were noted in eight echocardiograms.

Conclusion:

Echocardiography in the evaluation of “rarely appropriate” and “may be appropriate” palpitation-related indications is of low diagnostic yield.

Keywords

Paediatric appropriate use criteriapalpitationsechocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 1 , January 2021 , pp. 60 - 62
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Lang, SM, Bolin, E, Hardy, S, Tang, X, Collins, RT, 2nd. Diagnostic yield of outpatient pediatric echocardiograms: impact of indications and specialty. Pediatr Cardiol 2017; 38: 162–169. doi: 10.1007/s00246-016-1497-1 CrossRefGoogle ScholarPubMed
Weber, BE, Kapoor, WN. Evaluation and outcomes of patients with palpitations. Am J Med 1996; 100: 138–148. doi: 10.1016/s0002-9343(97)89451-x CrossRefGoogle ScholarPubMed
Campbell, RM, Douglas, PS, Eidem, BW, Lai, WW, Lopez, L, Sachdeva, R. ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE 2014 appropriate use criteria for initial transthoracic echocardiography in outpatient pediatric cardiology: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Academy of Pediatrics, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Coll Cardiol 2014; 64: 2039–2060. doi: 10.1016/j.jacc.2014.08.003 CrossRefGoogle Scholar
Sachdeva, R, Travers, CD, McCracken, CE, et al. Temporal trends in utilization of transthoracic echocardiography for common outpatient pediatric cardiology diagnoses over the past 15 years. J Am Soc Echocardiogr 2017; 30: 201–208. doi: 10.1016/j.echo.2016.12.008 CrossRefGoogle ScholarPubMed
Sachdeva, R, Allen, J, Benavidez, OJ, et al. Pediatric appropriate use criteria implementation project: a multicenter outpatient echocardiography quality initiative. J Am Coll Cardiol 2015; 66: 1132–1140. doi: 10.1016/j.jacc.2015.06.1327 CrossRefGoogle ScholarPubMed
Bethge, A, Penciu, O, Baksh, S, Parve, S, Lobraico, J, Keller, AM. Appropriateness vs value: echocardiography in primary care. Clin Cardiol 2017; 40, 1212–1217. doi: 10.1002/clc.22810 Google ScholarPubMed
Pelletier, JH, Blanchard, S, Chamberlain, RC, Hornik, CP, Campbell, MJ, Hill, KD. The use of echocardiography for pediatric patients presenting with syncope. J Pediatr 2017; 190, 43–48. doi: 10.1016/j.jpeds.2017.07.010 CrossRefGoogle ScholarPubMed
Chamberlain, RC, Pelletier, JH, Blanchard, S, Hornik, CP, Hill, KD, Campbell, MJ. Evaluating appropriate use of pediatric echocardiograms for chest pain in outpatient clinics. J Am Soc Echocardiogr 2017; 30, 708–713. doi: 10.1016/j.echo.2017.03.008 CrossRefGoogle ScholarPubMed
Kozak, PM, Trumbo, SP, Christensen, BW, Leverenz, DL, Shotwell, MS, Kingeter, AJ. Addition of price transparency to an education and feedback intervention reduces utilization of inpatient echocardiography by resident physicians. Int J Cardiovasc Imaging 2019; 35, 1259–1263. doi: 10.1007/s10554-019-01572-2 CrossRefGoogle Scholar
Rajagopalan, K, Potts, JE, Sanatani, S. Minimally invasive approach to the child with palpitations. Expert Rev Cardiovasc Ther 2006; 4, 681–693. doi: 10.1586/14779072.4.5.681 Google ScholarPubMed
Aman, R, Qureshi, AU, Sadiq, M. Yield of 48-hour Holter monitoring in children with unexplained palpitations and significance of associated symptoms. J Pak Med Assoc 2017; 67, 975–979.Google ScholarPubMed