Pediatric appropriate use criteria for echocardiography: implications for clinical practice.

The first pediatric Appropriate Use Criteria (AUC) were recently published by the American College of Cardiology. This document consists of common clinical scenarios for which a transthoracic echocardiogram is ordered in outpatient settings. Echocardiography is the most common imaging modality used in the outpatient setting to assess children with suspected heart disease. However, it is known that echocardiography is not cost-effective or high yield for some common indications such as chest pain, syncope, or murmurs. The AUC have been developed to guide physician decision-making for appropriate testing and to improve resource utilization. In addition to pediatric cardiologists, a wide variety of providers including pediatricians, family practitioners, and other pediatric subspecialists order this imaging test. Therefore, this document has a very broad audience. Although appropriateness criteria may be a new concept in the pediatric world, adult cardiologists have been using these standards for various invasive and noninvasive procedures for almost a decade. In the first half of 2000, because of the dramatic augmentation of cardiac imaging, concerns were raised about excessive spending on these tests compared with other areas of health care. Consequently, health plans started adopting a variety of strategies to manage utilization, such as preauthorization. Concurrently, the American College of Cardiology Foundation established an AUC Task Force to guide appropriate testing. The purpose of the AUC was to guide physicians about “when and how often” to order a given procedure in an individual patient on the basis of current scientific evidence and health care resources. The overall goals of the AUC are to evaluate patterns of care by physicians and to serve as a framework for appropriateness of care. The AUC are along the lines of the 6 tenets of a health care system defined by the Institute of Medicine, namely, a safe, timely, equitable, efficient, effective, and patient-centered health care system.