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[Pediatric evaluation of children with heart murmurs]
L K Hansen1, N H Birkebaek, H Oxhøj
1Børneafdelingen, Odense Universitetshospital.
Insights
General pediatricians can accurately rule out heart disease in over half of children with heart murmurs. This clinical evaluation avoids unnecessary further investigations for many young patients.
Area of Science:
- Pediatrics
- Cardiology
- Diagnostic Accuracy
Background:
- Heart murmurs in children often require specialist evaluation.
- Accurate initial assessment by non-specialists is crucial to avoid unnecessary referrals and investigations.
Purpose of the Study:
- To assess the diagnostic capability of non-specialized pediatricians in evaluating pediatric heart murmurs.
- To determine the impact of this initial clinical evaluation on the need for further cardiac investigations.
Main Methods:
- Prospective study of 100 children referred for heart murmur evaluation.
- Clinical assessment by general pediatricians categorized children into 'no heart disease,' 'heart disease,' or 'definite heart disease.'
- Confirmation via color Doppler echocardiography within two months.
Main Results:
- 53% of children were correctly diagnosed as having no heart disease by clinical evaluation alone.
- One child had insignificant peripheral pulmonary artery stenosis, correctly identified.
- The clinical assessment accurately acquitted the majority of children without heart disease.
Conclusions:
- Non-specialized pediatricians can effectively rule out heart disease in a significant proportion of children presenting with murmurs.
- Clinical evaluation alone, without laboratory tests, can prevent unnecessary investigations for about half of these children.
- This approach streamlines pediatric cardiology referrals and reduces healthcare costs.
Abstract:
In order to analyse the non-specialized paediatrician's ability to evaluate children with a heart murmur and the consequences of this evaluation for the need of further investigations, we made a prospective and consecutive study concerning 100 children who were referred for initial evaluation of a heart murmur. Based on the clinical evaluation, the children were assigned to one of the three categories of "no heart disease" "heart disease" or "definite heart disease". Within two months each child underwent a complete colour Doppler echocardiographic study. Except for one child with an insignificant peripheral pulmonary artery stenosis, 53% of the children were correctly diagnosed as having no heart disease. We conclude that clinical evaluation without laboratory tests performed by paediatricians without any special training in cardiology could correctly acquit half of the children of heart disease, with no need for further investigation.