Key result
Appropriate inpatient TTE alters clinical management in ~78% of cases.
Why the study?
Rising transthoracic echocardiography use has raised concerns regarding underutilization and inappropriate ordering, while integration of established appropriate use criteria into routine clinical practice remains inconsistent.
Does inpatient transthoracic echocardiography evaluated by Appropriate Use Criteria align with clinical judgment and lead to changes in patient management in hospitalized adults?
Observational (n=1,246)
No
Does inpatient transthoracic echocardiography evaluated by Appropriate Use Criteria align with clinical judgment and lead to changes in patient management in hospitalized adults?
Inpatient transthoracic echocardiography shows high concordance between clinical judgment and 2011 Appropriate Use Criteria, and frequently leads to changes in clinical management even when classified as inappropriate or uncertain.
Answers are grounded in this paper and cite their sources.
High inpatient TTE appropriateness supports AUC adherence; leaves open whether criteria improve outcomes in broader settings.
Background: Transthoracic echocardiography (TTE) is a cornerstone in the evaluation of cardiovascular conditions. However, its increasing use has raised concerns about both underutilization in critical scenarios and inappropriate use in other scenarios. Although the American College of Cardiology Foundation, the American Heart Association, and the American Society of Echocardiography have proposed appropriate use criteria (AUC), their integration into routine clinical practice remains inconsistent. This study evaluated the appropriateness of inpatient TTE requests, their impact on medical decision-making, and the concordance between clinical judgment and AUC guidelines. Methods: A retrospective study was conducted on patients over 18 years of age who underwent TTE at the National University Hospital of Colombia between April 2016 and December 2019. This study analyzed the clinical justification for TTE use, changes in patient management, and interobserver agreement using the 2011 AUC and the PABAK-OS statistic. Results: Among the 1246 TTEs reviewed, 84.8% were deemed appropriate, 12.4% were inappropriate, and 2.4% were uncertain. Notably, 78% of the echocardiograms led to changes in clinical management. Even in cases classified as inappropriate or uncertain, a substantial proportion (63.2% and 67.7%, respectively) resulted in therapeutic adjustments. The agreement between the observers in terms of AUC categorization was high (PABAK-OS 0.87), and the concordance between the clinical judgment and AUC reached a PABAK-OS of 0.8. Conclusion: This study confirms that TTE remains highly useful in guiding clinical decisions. While clinical judgment aligns well with AUC guidelines, enhancing integration through decision-support tools may further optimize echocardiography use in hospitalized settings.
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Sánchez-Castillo et al. (2026) conducted an observational in Cardiovascular conditions requiring inpatient transthoracic echocardiography (n=1,246). In-hospital transthoracic echocardiography (TTE) evaluated by 2011 Appropriate Use Criteria (AUC) vs. Clinical judgment / inappropriate or uncertain AUC categories was evaluated on Appropriateness of TTE requests, changes in clinical management, and concordance with AUC (PABAK-OS 0.87 (interobserver); PABAK-OS 0.8 (clinical judgment vs AUC)). Inpatient transthoracic echocardiography was appropriate in 84.8% of cases and altered clinical management in 78%, with high clinical judgment-AUC concordance (PABAK-OS 0.8).
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