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Accuracy of clinical assessment of heart murmurs by office based (general practice) paediatricians
1Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
Insights
Pediatricians
Area of Science:
- Pediatric cardiology
- Diagnostic accuracy
- Clinical examination
Background:
- Heart murmurs are common in children.
- Distinguishing pathological from innocent murmurs is crucial.
- Office-based pediatricians perform initial evaluations.
Purpose of the Study:
- To assess the diagnostic accuracy of pediatricians in evaluating heart murmurs.
- To identify factors influencing diagnostic performance.
- To inform strategies for improving murmur assessment.
Main Methods:
- 30 office-based pediatricians evaluated children with heart murmurs.
- Paediatricians performed blind examinations.
- Sensitivity and specificity were calculated.
Main Results:
- Mean sensitivity was 82% and specificity was 72% for differentiating murmur types.
- Referral strategies could improve sensitivity to 87% and specificity to 98%.
- Accuracy correlated with referral practices and confidence, not demographics.
Conclusions:
- The diagnostic accuracy of pediatricians for heart murmurs is suboptimal.
- Educational interventions are needed to enhance accuracy.
- Improved strategies can reduce unnecessary referrals and misdiagnoses.
Aim:
To determine the diagnostic accuracy of physical examination by office based (general practice) paediatricians in the evaluation of heart murmurs.
Design:
Each of 30 office based paediatricians blindly examined a random sample of children with murmurs (43% of which were pathological). Sensitivity and specificity were calculated and were related to paediatricians' characteristics.
Results:
Mean (SD) sensitivity was 82 (24)% with a mean specificity of 72 (24)% in differentiating pathological from innocent murmurs, with further investigations requested for 54% of assessments. The addition of a referral strategy would have increased mean sensitivity to 87 (20)% and specificity to 98 (8)%. Diagnostic accuracy was not significantly related to the paediatricians' age, education or practice characteristics, but was related to referral practices and confidence in assessment.
Conclusions:
Diagnostic accuracy of clinical assessment of heart murmurs by office based paediatricians is suboptimal, and educational strategies are needed to improve accuracy and reduce unnecessary referrals and misdiagnosis.