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Infective endocarditis in children: clinical analyses and evaluation of two diagnostic criteria
J M Del Pont1, L T De Cicco, C Vartalitis
1Section of Infectious Diseases, Hospital Italiano de Buenos Aires, Argentina.
Insights
The Duke criteria are superior for diagnosing infective endocarditis (IE) in children compared to von Reyn criteria. This new schema correctly identifies more definite IE cases and rejects fewer, improving pediatric diagnosis.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Diagnostic Criteria Evaluation
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves and inner lining.
- Accurate diagnosis in pediatric patients is crucial but can be challenging.
- Existing diagnostic criteria, like von Reyn, may have limitations in pediatric populations.
Purpose of the Study:
- To analyze clinical characteristics of pediatric patients with infective endocarditis.
- To compare the diagnostic efficiency of the Duke criteria versus the von Reyn criteria in this group.
- To determine the superiority of one diagnostic schema over the other for pediatric IE.
Main Methods:
- Retrospective review of clinical records for 38 pediatric patients diagnosed with IE.
- Categorization into subgroups based on presence (Subgroup A) or absence (Subgroup B) of predisposing heart disease.
- Comparison of clinical features, causative microorganisms, and diagnostic classification using both Duke and von Reyn criteria.
Main Results:
- Ventricular septal defect was the most common heart condition; central venous catheters were the most frequent predisposing factor.
- Duke criteria classified 59% of clinically defined cases as definite IE, compared to 34% probable by von Reyn criteria.
- Duke criteria rejected no cases, while von Reyn criteria rejected 25% (all classified as possible by Duke criteria).
Conclusions:
- The Duke criteria demonstrate superior diagnostic performance for pediatric infective endocarditis compared to von Reyn criteria.
- Duke criteria increase the number of definite IE diagnoses and reduce the number of rejected cases in children.
- Implementation of Duke criteria is recommended for improved accuracy in diagnosing pediatric IE.
Abstract:
A new diagnostic schema for infective endocarditis (IE), the Duke criteria, has been compared with the previously published criteria of von Reyn in adult patients. This study was designed to analyze the clinical characteristics of a group of pediatric patients with IE and to compare the diagnostic efficiency of both sets of criteria. We reviewed retrospectively the clinical records of 38 patients, 22 with predisposing heart disease (Subgroup A) and 16 with no known cardiologic abnormality (Subgroup B). Ventricular septal defect was the most frequent preexisting heart disease (31.8%) and central venous catheters were the most frequent predisposing factor (68.7%). Comparison of the clinical features between subgroups (A vs. B) showed differences only for the presence of a new regurgitant murmur (9% vs. 44%, P < 0.05) and a hemoglobin value < or = 10 g/dl (50% vs. 94%, P < 0.05). The most frequent microorganisms isolated were viridans streptococci (36%) in Subgroup A and Staphylococcus aureus (50%) in Subgroup B. Of the 6 pathologically confirmed cases all would have been classified as clinically definite by the Duke criteria, as compared with 2 of 6 being defined as probable and one being rejected by von Reyn criteria. Of the 32 cases clinically defined 19 (59%) were classified as definite by the Duke criteria, and 11 (34%) were probable by the von Reyn criteria (difference 25%, P < 0.01). Although no case of IE was rejected by Duke criteria, 8 (25%) were rejected by von Reyn criteria (difference 25%, P < 0.01), with all 8 classified as possible by Duke criteria. We conclude that the Duke criteria were superior to the von Reyn criteria for the diagnosis of pediatric IE, including more cases as definite and significantly fewer cases as rejected.