Impact of the COVID pandemic on quality measures in a pediatric echocardiography lab

• Type of Material: Article
• Authors: Anna-Claire Marrone, Children's Healthcare of Atlanta; Gemma Morrow, Children's Healthcare of Atlanta; Michael S Kelleman, Emory University; Joan Lipinski, Children's Healthcare of Atlanta; William Border, Emory University; Ritu Sachdeva, Emory University
• Language: English
• Date: 2022-12-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Published by Elsevier B.V.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ppedcard.2022.101549
• Title of Journal or Parent Work: Progress in Pediatric Cardiology
• Volume: 67
• Start Page: 101549
• End Page: 101549
• Keywords: Appropriate use criteria; COVID, Coronavirus disease; COVID; IQM, Image Quality Metric; TTE, Transthoracic echocardiogram; Transthoracic echocardiography; CEM, Comprehensive Echocardiographic Exam Metric; Quality metrics
• Research Categories: Health Sciences, Public Health; Biology, Biostatistics

Abstract

Background: The COVID pandemic necessitated an altered approach to transthoracic echocardiography, especially in COVID cases. Whether this has effected echocardiography lab quality is unknown. Objectives: We sought to determine whether echocardiography lab quality measures during the COVID pandemic were different from those prior to the pandemic and whether quality and comprehensiveness of echocardiograms performed during the pandemic was different between COVID and non-COVID patients. Methods: The four quality measures (diagnostic errors, appropriateness of echocardiogram, American College of Cardiology Image Quality metric and Comprehensive Exam metric in structurally normal hearts) reported quarterly in our lab were compared between two quarters during COVID (2020) and pre-COVID (2019). Each component of these metrics was also assessed in randomly selected echocardiograms in COVID patients and compared to non-COVID echocardiograms. Results: For non-COVID echocardiograms, the image quality metric did not change between 2019 and 2020 and the comprehensive exam metric improved. Diagnostic error rate did not change, and appropriateness of echocardiogram indications improved. When COVID and non-COVID echocardiograms were compared, the image quality metric and comprehensiveness exam metric were lower for COVID cases (image quality mean 21.3/23 for non-COVID, 18.6/23 for COVID, p < 0.001 and comprehensive exam mean 29.5/30 for non-COVID, 27.7/39 for COVID, p < 0.001). In particular, systemic and pulmonary veins, pulmonary arteries and aortic arch were not adequately imaged in COVID patients. For studies in which a follow-up echocardiogram was available, no new pathology was found. Conclusions: At our center, though diagnostic error rate did not change during the pandemic and the proportion of echocardiograms ordered for appropriate indications increased, imaging quality in COVID patients was compromised, especially for systemic and pulmonary veins, pulmonary arteries and arch. Though no new pathology was noted on the small number of patients who had follow-up studies, we are paying careful attention to these structures to avoid diagnostic errors going forward.