Document Detail

Precision and accuracy of clinical and radiological signs in premature infants at risk of patent ductus arteriosus.
MedLine Citation:
PMID:  7550818     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the precision (interobserver agreement) and accuracy (agreement with criterion standard) of clinical and radiological signs in premature infants at risk of patent ductus arteriosus (PDA) with left-to-right shunting. DESIGN: Masked comparison of clinical and radiological examination with Doppler flow echocardiography (criterion standard). SETTING: Neonatal intensive care unit. PATIENTS: One hundred infants with birth weights less than 1750 g were studied once between days 3 and 7 of life. A third of the cohort was intubated at the time of study. INTERVENTION: Five independent observers noted the presence or absence of an increased pulse volume, an active precordium, a heart murmur, a cardiothoracic ratio greater than 60%, increased pulmonary vascular markings on a concurrent chest x-ray film, and a relative increase of the cardiothoracic ratio compared with that from the previous chest x-ray film. Pulsed and color flow Doppler echocardiography was performed within 4 hours. All 100 tapes were reviewed by a second pediatric cardiologist. RESULTS: Twenty-three infants had a PDA with left-to-right shunting. The precision of clinical signs was modest, with average kappa values of 0.15 for pulse volume, 0.32 for precordium, and 0.41 for murmur. Pulse quality (43%) and murmur (42%) had the highest mean sensitivities. Corresponding specificities were 74% for pulse volume and 87% for murmur. The combination of a cardiac murmur with an abnormal pulse volume had the highest positive predictive value (77%). The radiological examination did not improve the observers' ability to distinguish between patients with and without PDA. CONCLUSIONS: The precision and accuracy of clinical and radiological signs of a PDA with left-to-right shunting are unsatisfactory. Therefore, Doppler flow echocardiography is required to diagnose PDA confidently in preterm infants between days 3 and 7 of life.
P Davis; S Turner-Gomes; K Cunningham; C Way; R Roberts; B Schmidt
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of pediatrics & adolescent medicine     Volume:  149     ISSN:  1072-4710     ISO Abbreviation:  Arch Pediatr Adolesc Med     Publication Date:  1995 Oct 
Date Detail:
Created Date:  1995-11-13     Completed Date:  1995-11-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9422751     Medline TA:  Arch Pediatr Adolesc Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1136-41     Citation Subset:  AIM; IM    
Department of Pediatrics, McMaster University, Hamilton, Ontario.
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MeSH Terms
Ductus Arteriosus, Patent / diagnosis*,  radiography,  ultrasonography
Echocardiography, Doppler*
Infant, Newborn
Infant, Premature*
Logistic Models
Observer Variation
Physical Examination / methods
Prospective Studies
Reproducibility of Results
Risk Factors
Sensitivity and Specificity

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

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