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Indications for echocardiography in the diagnosis of infective endocarditis in children
C A Sable1, J J Rome, G R Martin
1Department of Cardiology, Children's National Medical Center, Washington, D.C. 20010, USA.
Insights
Transthoracic echocardiography is not a reliable diagnostic tool for infective endocarditis (IE) in children without strong clinical suspicion. Echocardiograms are low-yield in diagnosing pediatric IE when physical findings or blood cultures are negative.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Diagnostic Imaging
Background:
- The diagnostic utility of transthoracic echocardiography (TTE) for infective endocarditis (IE) in children remains unclear.
- Clinical suspicion for IE is often based on physical examination and blood culture results.
Purpose of the Study:
- To evaluate the effectiveness of TTE in diagnosing IE in pediatric patients.
- To determine if TTE is beneficial only in cases with high clinical suspicion for IE.
Main Methods:
- Retrospective review of echocardiographic reports and medical records for 133 inpatients suspected of IE (1990-1992).
- Analysis of patient data based on physical examination findings, blood culture results, and echocardiogram outcomes.
Main Results:
- Of 133 patients, 59 (44%) had high clinical suspicion (positive blood cultures or physical findings).
- TTE was positive in only 7 of these 59 patients (12%) and negative in all 74 patients without high suspicion (p=0.003).
- Predictors of positive echocardiograms included new murmurs, embolic phenomena, heart failure, mechanical ventilation, and positive blood cultures.
Conclusions:
- TTE has a low diagnostic yield for IE in children lacking physical findings or persistently positive blood cultures.
- Echocardiography is unlikely to aid in diagnosing IE in children without significant clinical indicators.
Abstract:
The role of transthoracic echocardiography as a diagnostic tool in children suspected of having infective endocarditis (IE) has not been defined. We hypothesized that echocardiography is only useful in children in whom there is high clinical suspicion of IE based on physical examination findings or persistently positive blood cultures. Echocardiographic reports and medical records of all inpatients (n = 133) from 1990 to 1992 who underwent echocardiography for suspected IE were reviewed. Fifty-nine of the 133 patients (44%) identified had either persistently positive blood cultures (n = 48), physical examination findings of IE (n = 20), or both (n = 9). The echocardiogram was positive in 7 of these patients (12%) and negative in all 74 patients without positive physical findings or positive blood cultures (p = 0.003). A new or changing precordial murmur, embolic phenomena, congestive heart failure, mechanical ventilation, and positive blood cultures were predictive of positive echocardiograms for IE by univariate analysis. The presence of fever, immune deficiency, and central lines, alone or in combination, was not predictive of a positive echocardiogram. In the absence of physical findings or persistently positive blood cultures, echocardiography is a low-yield study and is unlikely to aid in the diagnosis of IE in children.