September 2014

The American College of Cardiology (ACC) participated in a joint project with the American Society of Echocardiography, the Society of Pediatric Echocardiography, and several other subspecialty societies and organizations to establish and evaluate Appropriate Use Criteria (AUC) for the initial use of outpatient pediatric echocardiography. Assumptions for the AUC were identified, including the fact that all indications assumed a first-time transthoracic echocardiographic study in an outpatient setting for patients without previously known heart disease. The definitions for frequently used terminology in outpatient pediatric cardiology were established using published guidelines and standards and expert opinion. These AUC serve as a guide to help clinicians in the care of children with possible heart disease, specifically in terms of when a transthoracic echocardiogram is warranted as an initial diagnostic modality in the outpatient setting. They are also a useful tool for education and provide the infrastructure for future quality improvement initiatives as well as research in healthcare delivery, outcomes, and resource utilization. To complete the AUC process, the writing group identified 113 indications based on common clinical scenarios and/or published clinical practice guidelines, and each indication was classified into 1 of 9 categories of common clinical presentations, including palpitations, syncope, chest pain, and murmur. A separate, independent rating panel evaluated each indication using a scoring scale of 1 to 9, thereby designating each indication as “Appropriate” (median score 7 to 9), “May Be Appropriate” (median score 4 to 6), or “Rarely Appropriate” (median score 1 to 3). Fifty-three indications were identified as Appropriate, 28 as May Be Appropriate, and 32 as Rarely Appropriate.