An assessment of transesophageal echocardiography studies rated as rarely appropriate tests for infective endocarditis at an academic medical center

Abstract

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. K E Y W O R D Sinfective endocarditis, transesophageal echocardiography, vegetations | 2071 AMUCHASTEGUI ET Al.

Factor Analysis of the Prediction of the Postpartum Depression Screening Scale

“…However, much of the information has been neglected in previous studies. Additionally, some studies [18][19][20][21] examined the role of socioeconomic variables in screening practices; however, these studies were not based on the PDSS questionnaire. Our results are obtained from a tangible pregnancy database based on the PDSS questionnaire.…”

“…Duggan and Molina [19] studied the differences in socioeconomic variables and knowledge of screening practices and concluded that community-level factors in medically underserved areas may influence screening practices. Amuchastegui and Hur [20] included demographics as a major criterion of improvement to the screening process for infective endocarditis (IE). Chen and Cross [21] found women who lack social support, have an unstable economic status, and those experiencing acculturation were more likely to suffer depression.…”

An appraisal of clinical practice guidelines for the appropriate use of echocardiography for adult infective endocarditis—the timing and mode of assessment (TTE or TEE)

“…In the meantime, it should be available for timely and accurate guidance for the diagnosis and management of IE. As per a single-center study, a considerable number of transesophageal echocardiography (TEE) studies were rated as rarely appropriate tests for infective endocarditis (IE) [5]. Over the past 15 years, there are 9 guidelines that cover IE diagnosis and contain evidence-based recommendations on the appropriate use of Echo (only in English language, and the latest version of updating guidelines).…”

An appraisal of clinical practice guidelines for the appropriate use of echocardiography for adult infective endocarditis—the timing and mode of assessment (TTE or TEE)

“…Timely and accurate guidance should be available for the diagnosis and management of IE. As per a single-center study, a considerable number of transesophageal echocardiography (TEE) exams were rated as inappropriately used for IE [5]. Over the past 15 years, there have been 9 guidelines that cover IE diagnosis and contain evidence-based recommendations on the appropriate use of echo (all published in English, and the latest version of each guideline was considered).…”