Medical College of Wisconsin
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Evaluation of coronary CTA Appropriateness Criteria in an academic medical center. J Am Coll Radiol 2010;7(2):125-31

Date

02/10/2010

Pubmed ID

20142087

DOI

10.1016/j.jacr.2009.08.013

Scopus ID

2-s2.0-84928096408 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

BACKGROUND: The aim of this study was to evaluate published appropriateness criteria for CT angiography (CTA) at the authors' academic medical center.

METHODS: Two observers independently reviewed the medical records of 251 patients who had undergone dual-source coronary CTA from June 1 to December 31, 2007. Patients were assigned to indications from 1 of 7 tables from the American College of Cardiology Foundation and ACR Appropriateness Criteria. Agreement between the two observers was assessed using kappa statistics. Disagreements were resolved by consensus panel. The final numbers of appropriate, uncertain, inappropriate, and not classifiable indications were recorded.

RESULTS: Indications for testing were classified as appropriate in 69 patients (27%), inappropriate in 42 patients (17%), and uncertain in 25 patients (10%). One hundred fifteen indications for coronary CTA (46%) were not classifiable. Analysis of interobserver variability for overall appropriateness yielded a kappa value of 0.31, which was considered to indicate fair agreement.

CONCLUSION: The results of this study suggest that a significant proportion (46%) of the coronary CTA studies performed at the authors' institution are for indications that are not covered by the published appropriateness criteria. Modifications to these criteria could help decrease the number of studies that are not classifiable. Physician education could decrease the number of inappropriate studies.

Author List

Miller JA, Raichlin E, Williamson EE, McCully RB, Pellikka PA, Hodge DO, Miller TD, Gibbons RJ, Araoz PA

Author

Eugenia Raichlin MD Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
Coronary Angiography
Coronary Artery Disease
Female
Guideline Adherence
Humans
Male
Minnesota
Observer Variation
Practice Guidelines as Topic
Reproducibility of Results
Sensitivity and Specificity
Tomography, X-Ray Computed
United States