A single-centre audit of request forms and the 2011 appropriate use criteria for transthoracic echocardiography.

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Date: Sept-Dec 2020
From: Port Harcourt Medical Journal(Vol. 14, Issue 3)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Article
Length: 2,906 words
Lexile Measure: 1390L

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Byline: Ejiroghene. Umuerri

Background: Transthoracic echocardiography (TTE) is a useful diagnostic tool in cardiology practice. The information provided by the requesting physician is a helpful guide in the interpretation of findings. This study aimed to audit echocardiography request forms (ECFs). Methods: A 3-year retrospective audit of echocardiography request forms (ERFs) received at a community-based echocardiography centre in Delta State, Nigeria. Delta State University Teaching Hospital Health Research Ethics Committee granted ethical approval to conduct this study. Data extracted from the ERFs were patients' name, age, sex, address and indication/background clinical information, the name and signature of requesting physician, name of referring hospital and date of the request. Evaluation of the appropriateness of the indications for echocardiography was done using 2011 Revised American College of Cardiology Foundation's appropriate use criteria (AUC). The corresponding echocardiograms were coded as normal or abnormal reports. Data were anonymised and analysed using the SPSS software version 23. Results: All the 412 ERFs audited had the names of the patients. The patients' age, sex and address were missing in 22.6%, 11.4% and 92.5% of the ERFs, respectively. A total of 119 (28.9%) ERFs lacked indication/clinical information and thus unclassifiable using the 2011 AUC. Of the remaining ERFs, the AUC was appropriate, inappropriate and uncertain in 259 (88.4%), 26 (8.9%) and 8 (2.7%), respectively. Majority of the ERFs with uncertain indications had normal echocardiograms. The echocardiograms of 78% (93/119) of the patients whose ERFs lacked indication/clinical information were abnormal. Conclusion: In this study, ERFs were inadequately filled. However, majority of the stated indications/clinical information for TTE were classified as appropriate.


Globally, the burden of heart disease is enormous and rising.[1] Echocardiography is presently a mainstay, perhaps a baseline, investigative modality for diagnosing the presence and extent of structural and functional damage to the heart. Transthoracic echocardiography (TTE) is a noninvasive diagnostic tool. It is also a useful guide for pericardiocentesis. It competes favourably with other noninvasive cardiac imaging modalities such as computerised tomographic (CT) scan and magnetic resonance imaging (MRI).[2] It is relatively less time-consuming and more cost-effective compared to a CT scan and MRI. However, its use is operator dependent, and the information provided by the requesting doctor may be a useful guide in the interpretation of findings.[3]

TTE is a widely used investigative tool in developed countries. However, TTE is not readily available in most hospitals in Nigeria, especially at the primary and secondary levels of care. The demand for TTE modality is increasing. Consequently, requests for TTE come from within and outside the centres where the facility is domiciled. Indeed, this pattern is not peculiar to Nigeria.[4],[5] Across the globe, requests for echocardiography are received from cardiologists and non-cardiology specialists as well as general medical practitioners. To forestall the under-use and over-use of TTE, the European Association of Cardiovascular Imaging and the American College of Cardiology Foundation (ACCF) have independently developed appropriate use criteria (AUC) for TTE.[6],[7] The ACCF defined TTE requests as appropriate for initial diagnosis when there is a change in patient's...

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Gale Document Number: GALE|A656645786