The application of appropriate use criteria for transthoracic echocardiography in a cardiac intensive care unit

Background Appropriate use criteria ( AUC ) represent an important mechanism by which to promote the rational utilization of healthcare resources. No study to date has been conducted assessing the applicability of current AUC to transthoracic echocardiograms ( TTE s) performed in a cardiac intensive care unit ( CICU ). We analyzed 2 years of consecutive TTE s performed in a CICU at a quaternary‐care academic medical center, hypothesizing that current AUC may not adequately describe the role of TTE in a modern CICU . Methods Indications for TTE s were independently classified by two investigators in accordance with 2011 AUC . If investigators were unable to assign an AUC classification to a given study, it was deemed to be unclassifiable. Disagreements between investigators were resolved by consensus. Cases in which consensus could not be reached underwent definitive adjudication by a third investigator. Results Of the 826 TTE s, 619 TTE s were classified as appropriate (74.9%, CI 71.8%–77.9%), 12 as uncertain (1.5%, CI 0.75%–2.5%), 21 as rarely appropriate (2.5%, CI 1.6%–3.9%), and 174 were unable to be classified (21.1%, CI 18.3%–24.0%). The most common unclassifiable indication was “initial evaluation of cardiac structure or function after cardiac arrest of unknown etiology” (n = 101). Conclusion Current AUC for TTE s may not adequately address the complexity of clinical cases encountered in the CICU . In our study of 826 consecutive TTE s, 21.1% were unable to be classified, reflecting the difficulty in applying AUC to this unique clinical environment. Further studies are therefore needed to better delineate the appropriateness of TTE s performed in the CICU .