Ecocardiograma não deve mudar o diagnóstico. Ou mudá-lo raramente.


echo13725-fig-0001

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Appropriate use of echocardiography and relation to clinical decision making in both inpatients and outpatients in a developing country

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Methods

Prospective analysis of referrals from January to December 2014. Appropriateness and endpoints analyzed in different time points from medical archives. Endpoints: (1) change in the diagnosis, (2) indication for another method to complete the diagnosis, (3) change in clinical treatment, (4) indication for a treatment intervention, or (5) no change in management.

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Results

One thousand one hundred referrals were analyzed (55.5 ± 16.1 years, 44.6% male). 80.5% of referrals were appropriate (A), 11.2% “Rarely Appropriate” (RA), and 8.3% “May Be Appropriate” (MBA). Proportion of (A) did not differ between modalities (TTE-80.5% vs TEE-87.7% vs STR-81.2%, = .67). (A) referrals were more related to clinical decision than (RA)+(MBA) (38.9% [A] vs 15% [RA]+[MBA], < .001). The most frequent clinical indications of (RA) and (MBA) TTE were reevaluation of ventricular function without clinical change (AUC 10 and 11) and search of infectious endocarditis when low clinical probability (53).

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CONCLUSIONS

This study shows that, in a university public hospital from a developing country, use of echocardiography is based on appropriated rates very similar to other parts of the world. The study could also confirm that the clinical decision management is related to appropriateness of referrals. Three most frequent indications of TTE could be easily identified in this study as probably nonrelated to change in clinical decision management. Considering the long waiting time to have an echocardiogram in a public health institution of a developing country, cautiously revision of these TTE indications of referrals could be a good approach to enhance appropriateness and allow access to echo to a broader population.

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Estudo muito interessante das indicações de ecocardiograma segundo mérito de indicação.

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Achamos 80% de acerto nas indicações uma taxa muito boa.

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Porém, um exame bem indicado pode resultar em nenhuma mudança na conduta sem ser um demérito para a indicação.

Já um que muda o diagnóstico, pode revelar uma análise equivocada da história e exame físico.

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Parece ser uma assunto bem complexo a classificação do mérito da requisição.

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