Clinical Impact of Interobserver Agreement and Concordance of Appropriate Use Criteria for In-hospital Transthoracic Echocardiography
Fabian Andres Sanchez Castillo, Ingrid Tatiana Rojas-Ruiz, Luis Eduardo Silva, Manuel Agustin Paz, Laura Catalina Arcos-Medina, Estivalis Acosta-Gutierrez, Karen Yuliana Ramirez, Andres Felipe Linares-Vaca, Oscar Amaris, Gustavo A. Ramos-Espinosa, Guillermo Mora-Pabón, Arnold Méndez-ToroBackground:
Transthoracic echocardiography (TTE) is a cornerstone in the evaluation of cardiovascular conditions. However, its increasing use has raised concerns about both underutilization in critical scenarios and inappropriate use in other scenarios. Although the American College of Cardiology Foundation, the American Heart Association, and the American Society of Echocardiography have proposed appropriate use criteria (AUC), their integration into routine clinical practice remains inconsistent. This study evaluated the appropriateness of inpatient TTE requests, their impact on medical decision-making, and the concordance between clinical judgment and AUC guidelines.
Methods:
A retrospective study was conducted on patients over 18 years of age who underwent TTE at the National University Hospital of Colombia between April 2016 and December 2019. This study analyzed the clinical justification for TTE use, changes in patient management, and interobserver agreement using the 2011 AUC and the PABAK-OS statistic.
Results:
Among the 1246 TTEs reviewed, 84.8% were deemed appropriate, 12.4% were inappropriate, and 2.4% were uncertain. Notably, 78% of the echocardiograms led to changes in clinical management. Even in cases classified as inappropriate or uncertain, a substantial proportion (63.2% and 67.7%, respectively) resulted in therapeutic adjustments. The agreement between the observers in terms of AUC categorization was high (PABAK-OS 0.87), and the concordance between the clinical judgment and AUC reached a PABAK-OS of 0.8.
Conclusion:
This study confirms that TTE remains highly useful in guiding clinical decisions. While clinical judgment aligns well with AUC guidelines, enhancing integration through decision-support tools may further optimize echocardiography use in hospitalized settings.