Document Detail

Comparative study of clinical evaluation of heart murmurs by general pediatricians and pediatric cardiologists.
MedLine Citation:
PMID:  10500882     Owner:  NLM     Status:  MEDLINE    
In a study to compare the clinical diagnostic skills of academic general pediatricians and academic pediatric cardiologists in the evaluation of heart murmurs, a total of 128 patients (aged 1 month to 18 years) newly referred to a university pediatric cardiology clinic were evaluated by one of three general pediatricians and one of four pediatric cardiologists. The murmurs were clinically classified as innocent, pathologic, or possibly pathologic. The classification was revised after the review of electrocardiogram (EKG) and chest radiograph (CXR), if indicated. The definitive diagnosis was ascertained by echocardiography (94 normal, 34 abnormal). The general pediatricians identified as many pathologic heart murmurs as the pediatric cardiologists (27/34 vs. 29/34), with no difference in sensitivity, 79% vs. 85% (p = 0.53). The similarity in sensitivity could be because the general pediatricians were more cautious in the classification of heart murmurs and had classified more innocent heart murmurs as pathologic than the pediatric cardiologists (13/39 vs. 3/23), 41% vs. 13% (p = 0.02). The pediatric cardiologists correctly identified more innocent murmurs than general pediatricians (52/94 vs. 72/94), with a better specificity, 55% vs. 76% (p = 0.001); however, the accuracy of prediction of innocence was similar for both groups (52/59 vs. 72/77), 88% vs. 93% (p = 0.36). The revision of diagnosis with review of EKG and CXR was more often misleading than helpful for either group. Academic general pediatricians would identify most of the pathologic murmurs and are no more likely than an academic pediatric cardiologist to misclassify a pathologic heart murmur as innocent.
K Rajakumar; M Weisse; A Rosas; E Gunel; L Pyles; W A Neal; A Balian; S Einzig
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical pediatrics     Volume:  38     ISSN:  0009-9228     ISO Abbreviation:  Clin Pediatr (Phila)     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-10-04     Completed Date:  1999-10-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372606     Medline TA:  Clin Pediatr (Phila)     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  511-8     Citation Subset:  AIM; IM    
Department of Pediatrics, West Virginia University (WVU) School of Medicine, Morgantown 26506, USA.
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MeSH Terms
Child, Preschool
Heart Defects, Congenital / physiopathology
Heart Diseases / physiopathology
Heart Murmurs / diagnosis*,  etiology
Interprofessional Relations
Comment In:
Clin Pediatr (Phila). 1999 Sep;38(9):519-20   [PMID:  10500883 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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