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Initial evaluation of children with heart murmurs by the non-specialized paediatrician
L K Hansen1, N H Birkebaek, H Oxhøj
1Department of Pediatrics, Odense University Hospital, Denmark.
Insights
General pediatricians can accurately assess children with heart murmurs, correctly clearing about half of them without further cardiac investigations. This approach avoids unnecessary echocardiograms for many young patients.
Area of Science:
- Pediatric Cardiology
- Diagnostic Accuracy in Pediatrics
Background:
- Heart murmurs are common in children, leading to frequent referrals for specialist evaluation.
- The diagnostic capabilities of non-specialized pediatricians in initial heart murmur assessments require further analysis.
Purpose of the Study:
- To evaluate the accuracy of general pediatricians in diagnosing pediatric heart murmurs.
- To determine the impact of initial clinical evaluation on the need for further cardiac investigations.
Main Methods:
- A prospective study involving 100 children referred for initial heart murmur evaluation.
- Assessment performed by pediatricians without specialized cardiology training.
- Follow-up included echocardiographic studies for a subset of patients.
Main Results:
- 53% of children were correctly diagnosed as having no heart disease by general pediatricians.
- Only one child had a minor peripheral pulmonary artery stenosis.
- No clinically significant heart disease was missed in the evaluated cohort.
Conclusions:
- Clinical evaluation by general pediatricians can accurately rule out heart disease in approximately 50% of children.
- This initial assessment can effectively prevent the need for further investigations, including echocardiography, in a significant number of cases.
Unlabelled:
To analyse the ability of the non-specialized paediatrician to evaluate children with a heart murmur and the consequences of this evaluation for the need of further investigations, we undertook a prospective and consecutive study of 100 children, referred for initial evaluation of a heart murmur. Except for 1 child with a slight peripheral pulmonary artery stenosis, 53% of the children were correctly diagnosed as having no heart disease. In a project design where 47% of the children were referred for an echocardiographic study, no clinically significant heart disease was missed.
Conclusion:
Clinical evaluation without laboratory tests performed by paediatricians without any special training in cardiology could correctly acquit 50% of the children of heart disease, with no need for further investigation.