How Many Echocardiograms Should be Performed to Detect One Cardiac Abnormality in Patients <18 Years? Results from the “Performing Echocardiography to Detect Heart Disease (PED-HEART) Study”

Abstract

Introduction: Echocardiography is an important cardiac investigating tool, however, its appropriate use in patients <18 years has to be ascertained. Aim: The aim of this study was to assess the clinical indication of the referral for echocardiography in patients with abnormal and normal echocardiographic examination. Methods: Single-center, retrospective observational analysis was done in patients <18 years who underwent echocardiography. This included patients’ clinical profiles and echocardiography examination findings. Results: Out of 7500 patients, normal echocardiography examinations (Group 1) were found in 75.33% (n = 5650) of the patients. Out of these (Group 1), 32.8% were referred for electrocardiographic changes, while 25% and 31% were for palpitation and chest pain, respectively. Patients with trivial findings on echocardiography were 350 (Group 2). Patients with a significant abnormality on echocardiography requiring medical management (Group 3) or cardiac intervention (Group 4) were 1250 and 250, respectively. The comparison of Group A (combined Groups 1 and 2 patients) with Group B (combined Groups 3 and 4 patients) showed that the referrals made for murmur, suspected heart failure, chest X-ray abnormalities, abnormal blood pressure/shock, and multiple parameters were found to be an independent predictor of abnormal findings on echocardiography. Conclusion: Abnormal findings on echocardiography requiring cardiac intervention in patients <18 years is one in every five echocardiograms performed in this study. The implementation of appropriate use criteria for echocardiography may help in improving this ratio.