Common indications and impact on clinical management of overnight, inpatient transthoracic echocardiograms performed by pediatric cardiology fellows

• Published in: Progress in pediatric cardiology Vol. 66; p. 101514
• Main Authors: Lorimer, Dean, Spies, Rachel, Chokshi, Riti, Lee, Caroline K., Colombo, Jamie N.
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.09.2022
• Subjects: Congenital heart disease; Echocardiogram; Pediatric cardiology fellows; Echocardiogram; Congenital heart disease; Pediatric cardiology fellows
• ISSN: 1058-9813; 1558-1519
• DOI: 10.1016/j.ppedcard.2022.101514

One of the core competencies of pediatric cardiology fellowship training is to perform and interpret transthoracic echocardiograms. Each institution is responsible for developing a curriculum surrounding this skill, yet there is little literature about the most common indications and the utility of these studies. The aims of this study are to determine the most common indications for overnight, inpatient transthoracic echocardiograms in pediatric patients performed by fellows and to evaluate their impact on clinical management. Retrospective chart review was completed for all transthoracic echocardiograms performed overnight by pediatric cardiology fellows during a one-year period. Study indication, result, and ordering hospital unit were obtained. Transthoracic echocardiograms impact was classified based on documentation in the medical record. Two hundred and twenty-five overnight transthoracic echocardiograms were performed on 186 patients; 46% had underlying structural heart disease. The most common indication was for assessment of left ventricular function (40.9%). The Heart Center (combined cardiac intensive care unit and step-down unit) was the most common ordering unit (40%). Fifty-four percent of studies were documented in the medical record as having impacted clinical decision-making. The indications resulting in the highest clinical impact were evaluation of shunt patency (100%) and confirmation of prenatally diagnosed congenital heart disease (86%). Clinical impact of overnight, inpatient transthoracic echocardiograms was higher in patients with known heart disease compared to those without (67% vs 43%). Pediatric cardiology fellow education should emphasize early training for assessment of left ventricular function and high impact indications in patients with congenital heart disease. Impact of overnight transthoracic echocardiograms is highest when used in children with underlying heart disease. •Medical management was impacted in 54% of patients who had an echocardiogram.•Assessment of left ventricular function was the most common ordering indication.•Echocardiogram utility was highest in patients with known structural heart disease.