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Evaluation of a novel method for grading heart murmur intensity
Ron Keren1, Michele Tereschuk, Xianqun Luan
1Division of General Pediatrics, Pediatric Generalist Research Group, Children's Hospital of Philadelphia, 3535 Market Street, Philadelphia, PA 19104, USA. keren@mail.chop.edu
Insights
A new method using heart sounds as an internal reference improved heart murmur intensity grading accuracy and consistency for medical professionals. This technique showed particular benefits for attending physicians and students grading specific murmur grades.
Area of Science:
- Cardiology
- Medical Education
Background:
- Accurate grading of heart murmur intensity is crucial for diagnosis and management.
- Current grading methods may lack consistency and accuracy among healthcare providers.
Purpose of the Study:
- To evaluate if using heart sounds as an internal reference can enhance the performance of heart murmur intensity grading.
Main Methods:
- A single-blind controlled trial involved 100 participants (students, residents, attending physicians).
- Participants were assigned to an intervention group (taught a new grading system) or a control group.
- Performance was assessed by accuracy, interrater agreement, and consistency in grading recorded murmurs.
Main Results:
- The intervention group showed greater improvement in grading accuracy compared to the control group.
- Significant improvements were observed in attending physicians and students, and for grade 2 murmurs.
- Enhanced consistency was noted for attending physicians and for grades 2 and 3 murmurs.
Conclusions:
- A system utilizing heart sounds as an internal reference effectively and rapidly improves heart murmur intensity grading.
- The benefits are most pronounced for certain provider levels and specific murmur grades, suggesting targeted training applications.
Objective:
To determine if heart murmur intensity grading performance can be improved using the heart sounds as an internal reference.
Methods:
Single-blind controlled trial of 100 medical students, residents, and pediatric attending physicians at a children's hospital. Groups of 1 to 3 participants were alternately assigned to intervention and control groups, reported their method of grading heart murmur intensity, and then graded the intensity of a random sample of 20 recorded murmurs on a 6-point scale. Before rating another random sample of 20 murmurs, the intervention group was taught a system that uses the heart sounds as an internal reference. Primary outcomes were change in accuracy (percentage correct), interrater agreement (kappa), and consistency (kappa). Subgroup analyses were performed by training level and heart murmur grade.
Results:
Grading accuracy improved more in the intervention group than the control group (Delta improvement, 5%; 95% confidence interval [CI], -0.1%-10.0%]). This was most pronounced among attending physicians (Delta improvement, 11%; 95% CI, 0.4%-22%) and students (Delta improvement, 12%; 95% CI, 3%-20%) and for grade 2 murmurs (Delta improvement, 20%; 95% CI, 10%-31%). Relatively greater improvements in consistency were observed after the intervention for attending physicians (Delta improvement, 0.17; 95% CI, 0.01-0.32) and grades 2 (Delta improvement, 0.22; 95% CI, 0.09-0.36) and 3 murmurs (Delta improvement, 0.16; 95% CI, 0.05-0.28).
Conclusions:
A system that uses the heart sounds as an internal reference for grading heart murmur intensity quickly improves accuracy and consistency for some providers and specific murmurs.
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