Transesophageal echocardiography for suspected infective endocarditis was rated as rarely appropriate in 18.6% of cases, though many were justified by immunosuppression or complex infections.
Cohort (n=194)
No
Nearly one-fifth of TEEs for suspected infective endocarditis were rated as rarely appropriate by standard criteria, though clinical nuances such as immunosuppression often justified their use.
PURPOSE: Endocardial involvement documented by echocardiography is a major criterion of the modified Duke criteria (MDC) for infective endocarditis (IE). Though transesophageal echocardiography (TEE) is sensitive in the diagnosis of IE, it can be inappropriately used. METHODS: This retrospective study included all patients who underwent TEE due to bacteremia, fever, and/or endocarditis in a single, tertiary academic medical center in 2013. Data collected from electronic medical charts were as follows: demographics, history, physical examination, blood cultures, and transthoracic (TTE) and TEE findings. Cases were categorized based on appropriate use criteria (AUC) and MDC. An infectious disease (ID) specialist reviewed cases with rarely appropriate TEE use. RESULTS: In the 194 patients included, 147 (75.8%) were rated as appropriate, 36 (18.6%) rarely appropriate, and 11 (5.6%) uncertain. Of the 36 with rarely appropriate TEEs, using MDC 31 (86%) were rejected and 5 (14%) were possible for IE. Retrospective chart review by an ID specialist determined that 10 of these patients warranted TEE due to compelling issues, including immunosuppression or complicated infection. CONCLUSIONS: In this retrospective cohort, almost one fifth of cases were rated as rarely appropriate. However, a review of these cases showed that TEE was often pursued when the clinical situation involved immunosuppression or complex infectious process. There remains room for improvement to our screening process for TEE and a need to implement a nuanced educational plan to better precisely identify appropriate cases for TEE usage.
Amuchástegui et al. (Fri,) conducted a cohort in Infective endocarditis (n=194). Transesophageal echocardiography (TEE) was evaluated on Appropriateness of TEE use based on appropriate use criteria (AUC). Transesophageal echocardiography for suspected infective endocarditis was rated as rarely appropriate in 18.6% of cases, though many were justified by immunosuppression or complex infections.
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