Document Detail

A decision aid for referring patients with systolic murmurs for echocardiography.
MedLine Citation:
PMID:  7996289     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To describe the practice pattern of a group of primary care providers in ordering echocardiography for healthy patients and to derive a decision aid to identify patients with systolic murmurs who have significant cardiac lesions. DESIGN: Retrospective case review of clinical variables, including the demographic, historical, and physical examination features obtained from chart review of the physician evaluation prior to referral for echocardiography and the echocardiographic results, with both univariate and multivariate regression analyses used to identify variables predictive of positive echocardiographic outcomes and to derive a regression model. SETTING: General internal medicine clinic in an urban major teaching hospital. PATIENTS/PARTICIPANTS: 169 patients between the ages of 18 and 55 years selected retrospectively from medical records. MEASUREMENTS AND MAIN RESULTS: Symptoms and auscultatory findings were not predictive of positive echocardiographic outcomes among the patients referred for the test. For the patients who had systolic murmurs, a logistic regression model had three significant predictors of positive echocardiographic results: additional year of age (odds ratio: 1.08, 95% CI: 1.02-1.13; p = 0.007); male gender (odds ratio: 5.87, 95% CI: 1.99-17.3; p = 0.002); and murmur grade > or = 3 (odds ratio: 4.99, 95% CI: 1.27-19.6; p = 0.02). The receiver-operating characteristic (ROC) curve area for this model was 0.741. If women aged 35 years and less with murmur grades < or = 2 had not been referred, 47% of the echocardiographies could have been avoided while retaining a sensitivity of 90%. CONCLUSIONS: The study suggested that healthy patients with systolic murmurs are least likely to have positive echocardiographic results when they are young and female and have murmur grades < or = 2. More careful screening of this group might make unnecessary almost half of the echocardiographies yielding negative results ordered for healthy patients with systolic murmurs.
J C Fink; C H Schmid; H P Selker
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of general internal medicine     Volume:  9     ISSN:  0884-8734     ISO Abbreviation:  J Gen Intern Med     Publication Date:  1994 Sep 
Date Detail:
Created Date:  1995-01-18     Completed Date:  1995-01-18     Revised Date:  2009-02-24    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  479-84     Citation Subset:  IM    
Division of Clinical Care Research, New England Medical Center, Boston, Massachusetts 02111.
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MeSH Terms
Decision Support Techniques*
Heart Murmurs / physiopathology,  ultrasonography*
Middle Aged
Physician's Practice Patterns
ROC Curve
Retrospective Studies
Risk Factors

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