Cardiac Murmurs in Children: A Challenge For The Primary Care Physician

Kostopoulou, Eirini; Dimitriou, Gabriel; Karatza, Ageliki

doi:10.2174/1573396315666190321105536

Cited by 19 publications

(25 citation statements)

References 33 publications

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“…Auscultation is the primary clinical tool to identify this murmur as innocent ( 8 , 9 ). Whereas pediatric cardiologists routinely perform this task, primary care providers (PCPs) have significantly less success in distinguishing Still's murmur from the murmurs of true heart disease ( 9 , 10 ). Their identification accuracy is higher (although still poor) for pathological murmurs (41%) and other innocent murmurs (45%) ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Automated identification of innocent Still's murmur using a convolutional neural network

Shekhar

Vanama²,

John

et al. 2022

Front. Pediatr.

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BackgroundStill's murmur is the most prevalent innocent heart murmur of childhood. Auscultation is the primary clinical tool to identify this murmur as innocent. Whereas pediatric cardiologists routinely perform this task, primary care providers are less successful in distinguishing Still's murmur from the murmurs of true heart disease. This results in a large number of children with a Still's murmur being referred to pediatric cardiologists.ObjectivesTo develop a computer algorithm that can aid primary care providers to identify the innocent Still's murmur at the point of care, to substantially decrease over-referral.MethodsThe study included Still's murmurs, pathological murmurs, other innocent murmurs, and normal (i.e., non-murmur) heart sounds of 1,473 pediatric patients recorded using a commercial electronic stethoscope. The recordings with accompanying clinical diagnoses provided by a pediatric cardiologist were used to train and test the convolutional neural network-based algorithm.ResultsA comparative analysis showed that the algorithm using only the murmur sounds recorded at the lower left sternal border achieved the highest accuracy. The developed algorithm identified Still's murmur with 90.0% sensitivity and 98.3% specificity for the default decision threshold. The area under the receiver operating characteristic curve was 0.943.ConclusionsStill's murmur can be identified with high accuracy with the algorithm we developed. Using this approach, the algorithm could help to reduce the rate of unnecessary pediatric cardiologist referrals and use of echocardiography for a common benign finding.

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Section: Introductionmentioning

confidence: 99%

Automated identification of innocent Still's murmur using a convolutional neural network

Shekhar

Vanama²,

John

et al. 2022

Front. Pediatr.

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“…Cardiac murmurs in children are common 20 and usually harmless. 21 In Finland, doctors already screen children for cardiac and other major physical health problems in health checks at the ages of 4-6 weeks, 4 months, 8 months, 18 months and 4 years. The doctors reported that half of their appointments with interventions were beneficial.…”

Section: Discussionmentioning

confidence: 99%

Associating school doctor interventions with the benefit of the health check: an observational study

Nikander

Kosola

Vahlberg

et al. 2022

bmjpo

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BackgroundThe benefits of school doctor interventions conducted at routine general health checks remain insufficiently studied. This study explored the associations of school doctor interventions with the doctor-evaluated and parent-evaluated benefits of routine health checks.MethodsBetween August 2017 and August 2018, we recruited a random sample of 1341 children from grades 1 and 5 from 21 Finnish elementary schools in 4 municipalities. Doctors routinely examined all children, who were accompanied by parents. The doctor-reported interventions were categorised into six groups: instructions and/or significant discussions, prescriptions, laboratory tests and/or medical imaging, scheduling of follow-up appointments, referrals to other professionals and referrals to specialised care. Doctors evaluated the benefit of the appointment using predetermined criteria, and parents provided their subjective perceptions of benefit. Interventions and reported benefit were compared using multilevel logistic regression.ResultsDoctors reported 52% and parents 87% of the appointments with interventions beneficial. All interventions were independently associated with doctor-evaluated benefit (ORs: 1.91–17.26). Receiving any intervention during the appointment was associated with parent-evaluated benefit (OR: 3.25, 95% CI 2.22 to 4.75). In analyses of different interventions, instructions and/or significant discussions (OR: 1.71, 95% CI 1.20 to 2.44), prescriptions (OR: 7.44, 95% CI 2.32 to 23.91) and laboratory tests and/or medical imaging (OR: 3.38, 95% CI 1.34 to 8.55) were associated with parent-evaluated benefit. Scheduled follow-up appointments and referrals to other professionals showed no significant association with parent-evaluated benefit.ConclusionsDoctors and parents valued the appointments with interventions. Parents especially appreciated immediate help and testing from the doctor.Trial registration numberNCT03178331.

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“…Khasawneh et al also mentioned that murmurs and cyanosis are the most common clinical signs and symptoms and are the main referral indications in cyanotic CHD patients. 18,19 Cyanosis is a bluish discoloration of the skin and mucous membranes due to an increase in the concentration of reduced hemoglobin in the bloodstream. 20 In patients with cyanotic CHD, a shunt occurs from right to left and there is a mixing of oxygen-rich blood with carbon-dioxide-rich blood so that the blood flowing throughout the body has decreased oxygen saturation, resulting in manifestations of cyanosis in the patient.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Cyanotic Congenital Heart Disease at Dr. Soetomo General Hospital Surabaya

Alverina¹,

Utamayasa²,

Sembiring³

2022

J Indon Med Assoc

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Introduction. Cyanotic congenital heart disease (CHD) is an abnormality of the heart that causes blood with low oxygen content to circulate directly to the body.Objective. To evaluate the profile of cyanotic congenital heart disease at Dr. Soetomo General Hospital Surabaya.Methods. This is a descriptive study using medical records of cyanotic CHD patients aged ≤18 years old from June 2018 – May 2020. Gender, age, nutritional status, sign and symptom, type of cyanotic CHD, complication and treatment were taken as the variables.Result. Out of 116 patients in this study, the majority were male (58.62%). Most patients first diagnosed at the age of 0 – <1 year (76.72%) with normal nutritional status (51.72%). Tetralogy of Fallot (TOF) is the most common type (42.24%). Murmur was the most common sign and symptom (92.24%). Frequently observed complications were pneumonia (37.07%).Conclusion. Patients with cyanotic CHD are mostly male, diagnosed at the age of 0 – <1 year with normal nutritional status. TOF is the most common type. Most patients present with murmurs. Predominant complication is pneumonia.

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Cardiac Murmurs in Children: A Challenge For The Primary Care Physician

Cited by 19 publications

References 33 publications

Automated identification of innocent Still's murmur using a convolutional neural network

Automated identification of innocent Still's murmur using a convolutional neural network

Associating school doctor interventions with the benefit of the health check: an observational study

Characteristics of Cyanotic Congenital Heart Disease at Dr. Soetomo General Hospital Surabaya

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