Key result
Primary care providers order TTEs for rarely appropriate indications ~8-fold more than pediatric cardiologists.
Why the study?
The study evaluated appropriateness ratings and cost-effectiveness of transthoracic echocardiograms ordered by PCPs versus pediatric cardiologists for syncope using pediatric appropriate use criteria.
Does ordering transthoracic echocardiograms by primary care providers compared to pediatric cardiologists affect appropriateness ratings and cost-effectiveness in pediatric patients with syncope?
Observational
Does ordering transthoracic echocardiograms by primary care providers compared to pediatric cardiologists affect appropriateness ratings and cost-effectiveness in pediatric patients with syncope?
Absolute Event Rate: 61.5% vs 7.5%
p-value: p=<.001
Referring pediatric patients with syncope to a pediatric cardiologist is more cost-effective and results in fewer rarely appropriate echocardiograms compared to primary care providers ordering the test directly.
PCP-ordered TTEs in pediatric syncope linked to more rarely appropriate use; hypothesis-generating for cardiologist referral improving appropriateness.
The pediatric appropriate use criteria (AUC) were applied to transthoracic echocardiograms (TTE) ordered by primary care providers (PCPs) and pediatric cardiologists for the diagnosis of syncope to compare appropriateness ratings and cost-effectiveness. Included were patients ≤18 years of age from October 2016 to October 2018 with syncope who underwent initial outpatient pediatric TTE ordered by a PCP or were seen in Pediatric Cardiology clinic. Ordering rate of TTE by pediatric cardiologists, AUC classification, and TTE findings were obtained. PCPs ordered significantly more TTEs than pediatric cardiologists for “rarely appropriate” indications (61.5% vs 7.5%, P < .001). Cardiologists ordered TTEs at 17.2% of visits. Using appropriateness as a marker of effect, with the incremental cost-effectiveness ratio, it was more cost-effective ($543.33 per patient) to refer to a pediatric cardiologist than to order the TTE alone. This suggests that improved PCP education of the AUC and appropriate indications of TTEs for syncope may improve cost-effectiveness when using order appropriateness as a marker of effectiveness.
No takes yet. Share an insight, caveat, or question.
Thompson et al. (2021) conducted an observational in Syncope. TTE ordered by primary care providers vs. TTE ordered by pediatric cardiologists was evaluated on "Rarely appropriate" indications for TTE (p=<.001). Primary care providers ordered significantly more transthoracic echocardiograms for rarely appropriate indications compared to pediatric cardiologists (61.5% vs 7.5%, P<.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: