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PEDIATRICS Vol. 99 No. 6 June 1997, pp. 921
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It is the intent of this statement to inform pediatric providers on the appropriate use of echocardiography. Although on-site consultation may be impossible, methods should be established to ensure timely review of echocardiograms by a pediatric cardiologist. With advances in data transmission, echocardiography information can be exchanged, in some cases eliminating the need for a costly patient transfer. By cooperating through training, education, and referral, complete and cost-effective echocardiographic services can be provided to all children.
Advances in echocardiography, including the introduction of
Doppler and color flow mapping, have provided prompt, detailed, and
noninvasive diagnoses of cardiac disorders. Although performance of
echocardiographic studies in adults is fairly straightforward, the
nearly infinite variety of cardiovascular abnormalities in the infant
and child make similar studies in infants and children much more
difficult to perform and interpret.
Although echocardiographic equipment is now available in nearly all
communities in the United States, many areas do not have pediatric
cardiologists. Additionally, many community hospitals can treat
neonates with mild or moderate respiratory disease, but lack facilities
and personnel to treat children with cardiac diseases. Transfer to a
tertiary care center may be costly and disruptive to the family, but
may be life-saving. The challenge is to bring the technology and
expertise to the community hospital and to assure prompt transfer of
the infant with life-threatening congenital heart disease but to avoid
unnecessary transfers.
The American Academy of Pediatrics' 1995 policy statement with regard
to access to pediatric subspecialty services states that: "When the
services of a physician specialist or other health care professional
are needed by children, plans should use providers with appropriate
pediatric training and expertise. Pediatric-trained medical and
surgical specialists should have completed an appropriate fellowship in
their area of expertise and be certified by subspecialty boards in a
timely fashion if certification is available."1 In
virtually all parts of the country, pediatric cardiologists are
available by telephone to help guide the application of diagnostic studies and to aid in their interpretation. Should congenital heart
disease be indicated by echocardiographic findings, a physician specifically trained in pediatric cardiology should be consulted. In
emergency situations, data can be exchanged by telephone or fax. Within
a few hours' time, videotapes can be delivered by courier. Telephone
transmission of diagnostic images such as an echocardiogram can now be
accomplished.
Interpretation of echocardiographic studies is highly dependent on
appropriate and thorough collection of data by the ultrasound technologist. Although most community hospitals have sonographers skilled in performing echocardiographic studies in adults, these sonographers usually have little training or experience in performing studies in infants and children with serious congenital heart disease.
Sonographers based in community hospitals face several logistical
problems when placed in the position of needing further pediatric
training and experience. These problems consist of time away from their
community hospital, funding for training, and educational commitment
from their community hospitals and from a training center. These
problems can be solved if all involved parties (sonographer, community
hospital, community-based pediatricians, and tertiary pediatric
cardiology care centers) work together.
The American Academy of Pediatrics encourages all parties involved in
providing pediatric cardiology care to establish linkages among
themselves to ensure prompt, cost-effective administration of quality
echocardiographic services.
SECTION ON CARDIOLOGY, EXECUTIVE COMMITTEE 1995 TO 1996
ARTICLE
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Douglas Moodie, MD, Chairperson
J. Timothy Bricker, MD
Derek Fyfe, MD
Kenneth Jue, MD
Larry Mahoney, MD
John Moore, MD
Samuel Ritter, MD
John Kugler, MD, Ex-Officio Chairperson
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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This article has been cited by other articles:
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  R. A. Hurwitz and R. L. Caldwell Should Pediatric Echocardiography Be Performed in Adult Laboratories? Pediatrics, August 1, 1998; 102(2): e15 - 15. [Abstract] [Full Text] [PDF]
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