Accuracy of clinical assessment of heart murmurs by office based (general practice) paediatricians

Haney, Isabel; Ipp, Moshe; Feldman, William H.; McCrindle, Brian W.

doi:10.1136/adc.81.5.409

Cited by 68 publications

(60 citation statements)

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“…This skill has recently been shown to be suboptimal in office-based paediatricians and paediatric residents (4,5). Paediatricians are not alone in this plight.…”

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confidence: 99%

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The paediatrician and cardiac auscultation

Douglas¹

2003

Paediatrics &Amp; Child Health

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The cardiac auscultation (CA) skills of paediatric residents and office-based paediatricians have recently been shown to be suboptimal. CA is known to have a high degree of specificity and sensitivity, and is inexpensive. New teaching aids and availability of surrogate patient heart sounds and murmurs now allow most physicians to acquire CA skills. These teaching aids should be available in all medical schools and in all postgraduate paediatric training programs. While the relationship between musicality and CA skill has not been proven, the author assumes this relationship to be valid. Specific learning objectives in CA should be established. Recognizing that the current trend is away from clinical examinations, students frequently are unaware that a CA learning deficit exists. Therefore, students' CA skills should be evaluated before medical school graduation and at the Royal College of Physicians and Surgeons specialty examination. Students with amusia (inability to distinguish pitch of sound) should be identified and consideration should be given to directing them away from a clinical specialty in which CA is important. Further study is required in the physiology of learning of CA. Appropriate action by medical school and paediatric postgraduate program directors and the Royal College will effect a higher standard of patient care by increasing CA skills, resulting in a more financially efficient system -something everyone is trying to achieve in these times of increasing medical care costs.Key Words: Cardiac auscultation; Heart murmurs Le pédiatre et l'auscultation cardiaque Il a récemment été démontré que les compétences en matière d'auscultation cardiaque (AC) des résidents en pédiatrie et des pédiatres en cabinet sont sous-optimales. Il est établi que l'AC a un degré élevé de spécificité et de sensibilité et qu'elle est peu coûteuse. Du matériel didactique et l'accessibilité à des sons et à des murmures cardiaques de patients permettent maintenant à la plupart des médecins d'acquérir des compétences en AC. Ce matériel didactique devrait être disponible dans toutes les facultés de médecine et dans tous les programmes de formation surspécialisés en pédiatrie. Bien que le lien entre la musicalité et les compétences en AC n'ait pas été démontré, l'auteur en présume la validité. Des objectifs d'apprentissage précis de l'AC devraient être établis. Puisque la tendance actuelle s'éloigne des examens cliniques, il arrive souvent que les étudiants n'aient pas conscience de leur défaillance d'apprentissage en AC. Par conséquent, les compétences en AC des étudiants devraient être évaluées avant la collation des grades et à l'examen de spécialité du Collège royal. Les étudiants atteints d'asonie (incapacité de distinguer le ton des sons) devraient être repérés, et il faudrait envisager de les orienter loin d'une spécialité clinique dans laquelle l'AC est importante. Des études plus approfondies s'imposent sur la physiologie de l'apprentissage de l'AC. Des mesures pertinentes par les facultés de médecine, les directeur...

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“…This skill has recently been shown to be suboptimal in office-based paediatricians and paediatric residents (4,5). Paediatricians are not alone in this plight.…”

mentioning

confidence: 99%

“…Use of this program in second year medicine was also effective (12). Theoretically, paediatric residents should have a higher level of skill resulting from rotations through cardiac services, yet no improvement has been demonstrated with increased years of residency (4).…”

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The paediatrician and cardiac auscultation

Douglas¹

2003

Paediatrics &Amp; Child Health

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“…2,[8][9][10][11] Shry, dkk 12 menyatakan perbandingan antara pemeriksaan fisis dan ekokardiografi oleh ahli kardiologi anak mempunyai sensitivitas sebesar 100%, spesifisitas sebesar 67%, nilai prediksi positif sebesar 30% dan nilai prediksi negatif sebesar 100%. Haney, dkk 13 melaporkan sensitivitas dan spesifisitas pemeriksaan fisis oleh dokter spesialis anak 82% dan 24%, yang dengan pelatihan pengenalan bising jantung anak meningkat masing-masing menjadi 87% dan 98%. Mahnke, dkk 14 melaporkan bahwa kemampuan pengenalan bising jantung anak oleh residen sangat buruk dan perlu pelatihan khusus untuk meningkatkan kemampuan pengenalan bising jantung.…”

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Ketajaman Klinis dalam Mendiagnosis Bising Inosen

Solang¹,

Advani²,

Boediman³

2016

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Latar belakang. Bising inosen adalah bising yang tidak berhubungan dengan kelainanorganik atau kelainan struktural jantung. Kepustakaan menyebutkan bising inosenditemukan pada 50% populasi anak sehat. Bising ini tidak bersifat patologis tetapisering disalahartikan sebagai bising organik, sehingga dilakukan berbagai pemeriksaanpenunjang yang mahal yang sebenarnya tidak diperlukan. Ketajaman klinis seorang dokteranak dalam mendiagnosis bising inosen sangat penting untuk mengatasi biaya tinggidan rasa kecemasan orang tua terhadap kondisi anak. Ketajaman klinis ini dapat diperolehdengan pengalaman dan pelatihan khusus pengenalan bising jantung pada anak.Tujuan. Membandingkan sensitivitas dan spesifitas pemeriksaan fisis denganpemeriksaan ekokardiografi (sebagai baku emas) dalam mendiagnosis bising inosen.Metode dan subyek penelitian. Desain penelitian adalah uji diagnostik. Populasiterjangkau pasien berusia 0 bulan–12 tahun yang berobat di Poliklinik Anak Umum RSDr. Cipto Mangunkusumo dari tanggal 1 Agustus sampai 31 Oktober 2005. Populasitarget adalah pasien dengan bising jantung tanpa sianosis. Baku emas ekokardiografidilakukan pada semua pasien dengan bising jantung untuk mengkonfirmasi hasilpemeriksaan fisis.Hasil. Sensitivitas diagnosis bising inosen berdasarkan pemeriksaan fisis oleh penelitiadalah 97% dan spesifisitas 50%. Nilai duga positif adalah 91% dan nilai duga negatif75%. Rasio kemungkinan untuk hasil positif adalah 1,94 dan hasil negatif adalah 0,6(hasil uji sedang).Kesimpulan. Pemeriksaan fisis oleh peneliti yang telah mendapat pelatihan khususpengenalan bising jantung, cukup dapat dipercaya sehingga dapat menurunkan keharusanpemeriksaan ekokardiografi yang mahal. Pelatihan berkala mengenal jenis-jenis bisingjantung pada anak bagi peserta Program Dokter Spesialis Anak (PPDS) 1 Ilmu KesehatanAnak dan dokter spesialis anak sebaiknya dilakukan untuk menambah kompetensi dalammendiagnosis bising inosen dan menghindari biaya tinggi pemeriksaan penunjang.

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“…Innocent murmurs usually do not radiate, and the intensity may change with the child's position or respiration. 6 Haney et al evaluated the ability of 30 office based pediatricians to correctly identify pathologic murmurs in a group of patients with a known cardiac defect. 7 They reported a mean sensitivity of 82% and specificity of 72% regarding ability to differentiate pathologic from innocent murmurs.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of children with cardiac murmur using Nadas criteria

James¹,

Poornima

Ninan

2018

Int J Contemp Pediatr

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Background: Pediatricians often encounter children with heart murmurs during routine follow up visits or while assessment of intercurrent illness. Clinical differentiation between pathologic and innocent murmurs would be important. It is important to identify those children who need further evaluation. The aim of the study was to evaluate whether Nadas criteria can be applied as a screening test to decide on further workup.Methods: This was a prospective descriptive study done in Government T. D. Medical College, Alappuzha over a period of 12 months from July 2013 to June 2014. All children in the age group one month to 12 years, attending the outpatient department were screened for presence of murmur of grade 2 and more. They were further evaluated carefully. They were also studied for association of variables like maternal age, birthweight, dysmorphism and family history of heart disease. Nadas criteria was then applied to the study population. A score of 2 and 1 were given to major and minor criteria respectively.Results: 3070 children were screened. 150 children were detected to have murmur of grade2 and more.66 children were detected to have a structural heart disease by an echo study.74% of the study population in the age group <1 year had a heart disease.8 out of 78 children with a Nadas score of 1 and 10 out of 24 with a score of 2 had a heart disease. All with a score 3 and more had congenital heart disease (CHD).Conclusions: Nadas criteria can be used as screening test with a sensitivity of 87% and specificity of 83%.

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Accuracy of clinical assessment of heart murmurs by office based (general practice) paediatricians

Cited by 68 publications

References 14 publications

The paediatrician and cardiac auscultation

The paediatrician and cardiac auscultation

Ketajaman Klinis dalam Mendiagnosis Bising Inosen

Evaluation of children with cardiac murmur using Nadas criteria

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