Linked Life Data

10190408

Source:http://linkedlifedata.com/resource/pubmed/id/10190408

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PredicateObject
rdf:type
lifeskim:mentions
pubmed:issue
6
pubmed:dateCreated
1999-4-15
pubmed:abstractText
Although cardiologists who treat adults have been evaluating pediatric patients using echocardiography since the early 1980s, the diagnostic accuracy of such studies has never been tested. To prospectively assess diagnostic accuracy of pediatric echocardiograms performed in adult laboratories (adult-lab echos) compared with evaluations of the same patients in pediatric laboratories (pediatric-lab echos), we gathered data from 66 patients, ages 1 day to 18 years (median 19 months), who underwent adult-lab echos in community hospitals or private offices before evaluation by a pediatric cardiologist; subsequently, 65 underwent pediatric-lab echos in a university hospital laboratory. Echocardiographic diagnoses were compared with (1) diagnoses proved by catheterization or surgery (25 patients), and (2) echocardiographic diagnoses verified by blinded duplicate-observer review (41 patients). Eighteen patients had no cardiac disease; 42 had simple lesions, 5 had intermediate lesions, and 1 had a complex lesion. In 25 patients with 46 procedure-proven diagnoses, the most important error per adult-lab echo was major in 11 (44%), moderate in 7 (28%), and minor in 3 (12%); in pediatric-lab echos it was major in 0 (0%), moderate in 1 (4%), and minor in 1 (4%). In 41 patients with 62 duplicate-observer-verified diagnoses, the most important error per adult-lab echo was major in 5 (12%), moderate in 12 (29%), and minor in 5 (12%); pediatric-lab echos had no errors. In 35 of 66 adult-lab echos (53%), the most important error was major or moderate. Of these, 71% were interpretive, 17% technical, and 11% both. Error incidences were not related to patient age, study year, use of color Doppler, or complexity of diagnoses. In 29 of these 35 patients, pediatric-lab echos resulted in altered clinical management, including 12 surgeries and 2 averted surgeries. In 3 of the 29, delayed diagnoses were associated with fixed pulmonary vascular disease, hypoxemic spells, and vascular collapse with severe metabolic acidosis. This study reveals a high incidence of diagnostic errors in pediatric echocardiograms performed in community-based adult laboratories, despite a preponderance of patients with simple diagnoses or no heart disease.
pubmed:language
eng
pubmed:journal
pubmed:citationSubset
AIM
pubmed:status
MEDLINE
pubmed:month
Mar
pubmed:issn
0002-9149
pubmed:author
pubmed:issnType
Print
pubmed:day
15
pubmed:volume
83
pubmed:owner
NLM
pubmed:authorsComplete
Y
pubmed:pagination
908-14
pubmed:dateRevised
2006-11-15
pubmed:meshHeading
pubmed:year
1999
pubmed:articleTitle
Diagnostic accuracy of pediatric echocardiograms performed in adult laboratories.
pubmed:affiliation
Department of Pediatrics, The University of California, San Francisco, 94143, USA.
pubmed:publicationType
Journal Article, Comparative Study