Clinical & Experimental Cardiology
Open Access

Abstract

An Audit of Urgent Echocardiograms and an Analysis of Parental Understanding of a Normal Echocardiographic Study in a Regional Centre in Malta

Victor Grech, Josette Desira, Mark Bailey and Victor Mercieca

Introduction: Echocardiography is the modality of choice for investigation of suspected congenital or acquired heart disease. It may be used as part of the screening process for suspected heart disease in childhood after the incidental fi nding of a murmur, even if this is deemed to be an innocent murmur by the referring clinician. However some studies have shown that parents may misunderstand the implications of a normal test and may persistently restrict their child’s activity even after a normal echocardiogram. The second part of this study prospectively audited echocardiography requests for non-elective (urgent) echocardiograms, in the setting of a regional hospital that serves an entire captive island population for the period 2007. An analysis of parental understanding of a normal echocardiogram was also carried out.

Methods: All normal and all urgent echocardiograms were prospectively collected for the 2007 Parents were administered a telephone questionnaire with regard to their understanding of a normal echocardiogram, after one month. Information collected also included age of patient, delay from request to actual procedure, actual indication and echocardiographic outcome (diagnosis).

Results: 88 non-elective echocardiograms were performed with a bimodal age distribution ranging from 1 hour to 50 years. The majority were infants. 6 patients were aged over 14 years. The delay to the actual performance of the echocardiogram ranged from 2 hours to 20 days, with a mean of 2.8 days and a median of 1 day. The outcome was completely normal in 35 individuals, physiological for age in 14 individuals (total normal of 49 - 55%) and abnormal in 39.

89 normal echocardiograms were included. 79 parents stated that they were fully satis fi ed with the explanation and implications of a normal echocardiogram and 10 were almost fully satis fi ed. No signi fi cant differences could be found between these two groups. A hard copy was more likely to reassure the parents, but not at a statistically signi fi cant level. Only 77 had a full explanation with regard to the implications of an innocent murmur with echocardiographic con fi rmation but this too did not affect parental reassurance.

Discussion: 88 non-elective echocardiograms accounted for 10% of the total paediatric echocardiogram referrals for the period 2007, with a signi fi cant pick-up rate for pathological lesions.

For normal echocardiography examinations, this study con fi rms that parents are satis fi ed with an explanation of the implications of a normal echocardiogram. Our service can be improved by providing a full explanation to all parents and by adopting the policy of giving a hard copy of the normal report to all parents.