Application Of Appropriateness Use Criteria In Hospitalized Patients Referred For Emergency Bedside Echocardiography

Objective A recent Chinese Society of Echocardiography document created a new appropriateness use criteria (AUC) for emergency bedside echocardiography (EBE). The aim of this study was to explore the application of the new AUC, and the resulting appropriateness rate and clinical utility in hospitalized patients referred for EBE in a single-center hospital.Metholds A total of348consecutive inpatients referred for EBE were recruited form Cardiac Intensive Care Unit (CCU) and Emergency Department. Patients were categorized as appropriate, uncertain, or inappropriate indications for EBE according to AUC.Results In the group referred for EBE, the majority of indication (n=30286.8%) were classifiable according to the AUC with good interobserver reproducibility (kappa=0.89, P<0.001). Indications were appropriate in294patients (97.4%), uncertain in0patients (0%), inappropriate in8patients (2.6%, n=302). Most common causes of inappropriate indications were for the diagnosis of suspected pulmonary embolism (n=7,87.5%). Examination with appropriate indications had an impact on clinical decision making more often than those with inappropriate and unclassified indications (90.4%VS16.7%, p<0.0001)Conclusion Clinical application of the new AUC was feasible for EBE. Although inpatient referral for EBE was appropriate in most patients and appropriate indications was clinically useful, strategies aimed at implementing these criteria in clinical practice are desirable.