The objective of the current study is to identify clinical value of appropriateness use criteria in various patient and physician groups and to focus on downstream use of resources in relation to appropriateness.
This study evaluated SPECT appropriateness criteria in a diverse patient population. It included all patients undergoing SPECT in Kobry al Kobba military hospital and Ain Shams University hospitals throughout the period from February 2012 to august 2012.
It was noted that men were predominantly higher than women with 77% versus 23% respectively. Furthermore, men were higher in the group of Kobry Al Kobba military hospital (94%) than patients of Ain Shams University (62%).
This is higher than the results found by Regina et al. who investigated 570 patients with 55% of men and 45 % of women .
Diabetes, hypertension and smoking were investigated in our study as risk factors for ischemic heart disease and we found that 28% of patients were smokers, 58% hypertensive patients and 38% diabetics.
This is compared to Raymond J. et al., who investigated 284 patients undergoing SPECT imaging and found that 48% of patients were smoking, 71% with hypertension and 27% with diabetes .
Most of our patients had high or intermediate pretest probability 66%. It was noted that more patients with high or intermediate pretest probability were found in Kobry Al Kobba military hospital (79%) versus (58%) in Ain Shams university hospital.
On the other hand Regina et al. 2011 found that 51% of patients had low pretest probability and only 6% had high pretest probability .
FRS was calculated for asymptomatic patients with no history of CAD which predict 10-year incidence of CAD, most of the patients are in the low risk groups (57%).
This is supported by Regina et al. who found that 51% of the patients fall in the low risk category .
In the present study, the overall percent of appropriate studies was 78%. This is within the range found by Gibbons et al. 2008 who investigated the performance of appropriateness criteria for stress SPECT in 284 patients and found that 64% of SPECT studies were appropriate.
Also, Regina et al. found overall appropriate studies in the range of 63% .
On the other hand, we found that the overall inappropriate studies were forming 10% of all the studies done.
This finding is within the range reported by Gibbons et al. and Regina et al. which was (14%) [6, 12].
In our work, the uncertain or unclassified studies were found to be 15% of all studies.
This is supported Gibbons et al. who found that 10% of his studies were unclassified, but our findings were higher than that reported by Regina et al. who reported a 3% of unclassified studies [6, 12].
As regards center related findings, it was notable that the uncertain and inappropriate studies were higher in the university nuclear lab than that done in the military nuclear lab (15% versus 7%) respectively. This may be explained by the inclusion of more females in the university.
This finding was explained by Gibbons et al. who reported that almost 50% of inappropriate test were asymptomatic patients with a low FRS who were referred for screening for CAD .
The second large group of inappropriate tests was done in patients under consideration of intermediate risk surgery who had good exercise capacity and no or minor risk factors, and the third group of inappropriate patients were symptomatic patients with low pretest probability, and the final group were patients for low risk non-cardiac surgery .
These findings prove that specific scenarios may differ from institution to institution and the recognition of these general patterns in appropriateness criteria should be helpful to clinicians.
Women were more symptomatic that men and had a lower prevalence of known CAD.
Smaller number of included patients derived from 2 centers only over a relatively short period.
The inherited defects of FRS and its applicability on different ethnic groups such as Egyptians.