0541: The appropriate use criteria guidelines for echocardiography predict the clinical usefulness of transesophageal examinations in routine practice

Abstract

Management of increased referrals for echocardiography examinations is a daily challenge. Compared to transthoracic exploration, transesopha-geal echocardiography (TEE) is semi-invasive, and is more time consuming. Mainly based on expert consensus Appropriate Use Criteria guidelines for echo-cardiography (AUC) have been recently published. However, the ability of these criteria to predict the actual usefulness of TEE have not been yet well explored. To investigate the ability of AUC to predict the actual usefulness of TEE in daily clinical practice. Retrospective review of medical records from 436 TEEs carried out during a 1 year period was performed. The TTEs were classified according to the AUC guidelines and were also assessed for actual clinical usefulness blinded to AUC classification. The TEE was considered useless when the test results were finally not used for a medical decision impacting the clinical management of the patient. 85% of the TEEs were appropriate according to AUC and 82% were clinically useful. The agreement between the both classifications was good: 89% of the examinations were sorted similarly by the both methods (kappa=0.6). In multivariate analysis, independent factors linked to the TEE clinical usefulness were AUC classification as appropriate (Odd ratio = 62) and TEE orderings from the Cardiology department (Odd ratio = 2.4). The AUC Guidelines predict the clinical actual usefulness of TEE in Routine Practice. A larger use of these guidelines seem to be a good way to rationalize the TEE prescription in routine practice.