Comparison of the 2007 and 2011 Appropriate Use Criteria for Transesophageal Echocardiography

Background: The 2007 appropriate use criteria (AUC) for echocardiography were revised in 2011 to cover a wider range of scenarios of use. The aim of this study was to compare the 2011 AUC with the 2007 AUC to determine if the 2011 AUC better classify transesophageal echocardiography (TEE) and to determine the impact of the 2011 AUC on the rates of appropriate and inappropriate TEE at an academic medical center. Methods: A retrospective chart review was conducted to examine inpatient and outpatient TEE utilization. TEE ordering behavior was compared using both the 2007 and 2011 AUC, and studies were classified as appropriate, uncertain, inappropriate, or not classifiable. Results: We reviewed 202 consecutive transesophageal echocardiographic studies (154 inpatient, 48 outpatient) performed in 2011. Using the 2007 AUC, 166 studies (82%) were classifiable, and using the 2011 AUC, 199 (99%) were classifiable (P < .001). Among the classified studies, the percentage of appropriate studies using the 2007 AUC was 94% and using the 2011 AUC was 95% (P = .68). Using 2007 and 2011 AUC, the percentages of inappropriate studies were 0% and 4% (P = .02), and the percentages of uncertain studies were 6% and 1% (P = .006), respectively. Conclusions: The 2011 AUC classify a significantly greater proportion of transesophageal echocardiographic studies than the 2007 AUC. The rate of inappropriate studies using the 2011 AUC is higher than when using the 2007 AUC. These findings suggest that the expanded AUC offer an opportunity for improvement in the utilization of TEE. (J Am Soc Echocardiogr 2012;25:1170-5.)