Diagnostic accuracy of paediatric echocardiograms interpreted by individuals other than paediatric cardiologists

Abstract

This study suggests an unacceptably high error rate in paediatric echocardiographic diagnoses by non-paediatric cardiologists throughout all age groups. Such errors are more likely in younger infants and with increasing diagnostic complexity.

Diagnostic Errors in Pediatric Echocardiography

“…Previous studies have examined diagnostic accuracy; however, these reports have focused on targeted patient populations, 8,13 specific anatomic diagnoses, 14 and studies performed by nonpediatric cardiologists. 15,16 …”

Does point-of-care functional echocardiography enhance cardiovascular care in the NICU?

“…Unfortunately, the medical literature is dominated by a medicolegal debate on whether neonatologists should perform functional imaging with particular emphasis on the dangers of misdiagnosis of congenital heart disease (CHD). 11 Although the lessons from these publications should not be undermined, the potential benefits to patient care also need to be recognized. The four cases presented in this report provide real-life evidence of the potential impact of this advanced skill for neonatologists.…”

“…A number of recent publications highlight the benefits, barriers and risks along with issues of ownership, teaching and training. 1,11,27 The main concern regarding the use of PCFecho by neonatologists is the potential for misdiagnosisFeither missing significant CHD or commencing inappropriate treatment in misdiagnosed CHD. 1 These are real risks, and the development of training and accreditation processes for neonatal ultrasound should be aimed at minimizing these risks.…”

“…6,28 Even when an experienced neonatologist suspects CHD on a routine PCFecho, the pediatric cardiologist will oftentimes add more detail in refining the diagnosis. 7,11 Nevertheless, functional assessment performed at the bedside by the attending neonatologist should be considered in a comparable manner to the routine antenatal screen performed by midwives and obstetricians, where the expectation is not to provide exact anatomic detail. In addition, if there is clinical suspicion of CHD, pediatric cardiology consultation should be sought in a timely fashion.…”

Pulse Oximetry Screening in newborn for early detection of Critical Congenital Heart Disease - A review

“…Whenever possible, the echocardiogram should be interpreted by pediatric cardiologists as accuracy of pediatric echocardiograms by adult cardiologists is low. 30 Pulse oximetry improves detection rates of critical CHDs. The majority of critical cases missed by pulse oximetry (and by other screening methods) are associated with obstruction of the aortic arch as these conditions are often not associated with hypoxemia.…”