New outpatient referrals to a tertiary paediatric cardiac centre: evidence of increasing workload and evolving patterns of referral

Murugan, Subramanian Jothi; Thomson, John; Parsons, Jonathan; Dickinson, D F; Blackburn, M. E. C.; Gibbs, John L.

doi:10.1017/s1047951105000090

Cited by 33 publications

(32 citation statements)

References 2 publications

(2 reference statements)

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“…Pediatric cardiologists have an expanding role as they follow up these children and triage other children with murmurs (which usually prove to be innocent [23]). They also assess fetuses with suspected congenital heart disease and fetuses in high risk groups of pregnant women (11).…”

mentioning

confidence: 99%

Telemedicine in pediatric and perinatal cardiology: Economic evaluation of a service in English hospitals

Dowie

Mistry

Young

et al. 2007

Int J Technol Assess Health Care

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mentioning

confidence: 99%

Telemedicine in pediatric and perinatal cardiology: Economic evaluation of a service in English hospitals

Dowie

Mistry

Young

et al. 2007

Int J Technol Assess Health Care

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“…While a thorough clinical examination and electrocardiogram is, in most cases, sufficient to diagnose an innocent murmur, other centers have found that many parents are dissatisfied if an echocardiogram is not performed as they have been told their child is being "sent for a scan." 3,6 Of note, in this series of patients, 83.7% of those referred with an asymptomatic murmur were found to have normal hearts by 2012.…”

Section: Discussionmentioning

confidence: 63%

“…general hospitals would help reduce demands on the tertiary service. 3,5,8 To date in Northern Ireland there are no such pediatricians employed. The majority of referrals are for assessment of a murmur; this remains relatively unchanged in both time periods.…”

Section: Discussionmentioning

confidence: 99%

Referrals to Pediatric Cardiology Outpatients

Morrison

McCrossan

Sands

et al. 2016

Clin Pediatr (Phila)

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“…21 Moreover, substantial health care savings would be expected because of the decreased number of consultations and echocardiograms. 22 According to North American recommendations, echocardiograms should be performed only to assess a cardiac murmur when there is a family history of heart disease, cardiac symptoms, or abnormal clinical findings.…”

Section: Discussionmentioning

confidence: 99%

Auscultation While Standing: A Basic and Reliable Method to Rule Out a Pathologic Heart Murmur in Children

Lefort¹,

Cheyssac²,

Soulé³

et al. 2017

Ann Fam Med

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PURPOSEThe distinction between physiologic (innocent) and pathologic (organic) heart murmurs is not always easy in routine practice, leading too often to unnecessary cardiology referrals and expensive investigations. We aimed to test the hypothesis that the complete disappearance of murmur on standing can exclude cardiac disease in children.METHODS From January 2014 to January 2015, we prospectively included 194 consecutive children aged 2 to 18 years who were referred for heart murmur evaluation to pediatric cardiologists at 2 French medical centers. Heart murmur characteristics while supine and then while standing were recorded, and an echocardiogram was performed.RESULTS Overall, 30 (15%) of the 194 children had a pathologic heart murmur as determined by an abnormal echocardiogram. Among the 100 children (51%) who had a murmur that was present while they were supine but completely disappeared when they stood up, only 2 had a pathologic murmur, and just 1 of them needed further evaluation. Complete disappearance of the heart murmur on standing therefore excluded a pathologic murmur with a high positive predictive value of 98% and specificity of 93%, albeit with a lower sensitivity of 60%.CONCLUSIONS Disappearance of a heart murmur on standing is a reliable clinical tool for ruling out pathologic heart murmurs in children aged 2 years and older. This basic clinical assessment would avoid many unnecessary referrals to cardiologists. 2017;15:523-528. https://doi.org/10.1370/afm.2105. Ann Fam Med INTRODUCTIONH eart murmur is a clinical finding currently affecting about 65% to 80% of schoolchildren 1,2 and one of the most common reasons for referral to cardiologists. Most murmurs are physiologic (innocent) 3 and result from the normal pattern of blood flow through the cardiac cavities and vessels. In a few cases, however, the murmur may be the single symptom of cardiac disease, even if most congenital heart diseases are diagnosed before birth or during the first year of life. 1Differences between physiologic and pathologic murmurs are well known, 4-9 but primary care physicians in family medicine or pediatricians too frequently refer their patients to pediatric cardiologists because they fear missing a heart disease diagnosis, resulting in unneeded parental anxiety, time consumption, and expensive evaluations. 10,11 Several clinical features of the murmur such as intensity, timing, quality and pitch, and the presence of a click are subjective and require extensive training for use to distinguish between physiologic and pathologic murmur. A simple, objective, and robust clinical test to exclude cardiac disease in apparently healthy children could prevent many unnecessary referrals.McLaren et al 12 reported that the prevalence of physiologic heart murmur in schoolchildren was 65% when they were in a supine position, whereas it was only 15% when they were standing. To our knowledge, however, no study has demonstrated that the disappearance of murmur 524on standing can allow clinicians to rule out a murmur ...

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New outpatient referrals to a tertiary paediatric cardiac centre: evidence of increasing workload and evolving patterns of referral

Abstract: New referrals to centres dealing with congenital cardiac malformations are increasing alarmingly, with the majority of the children referred having normal hearts. This increase in demand for specialist services has important implications for resources and training.

Cited by 33 publications

References 2 publications

Telemedicine in pediatric and perinatal cardiology: Economic evaluation of a service in English hospitals

Telemedicine in pediatric and perinatal cardiology: Economic evaluation of a service in English hospitals

Referrals to Pediatric Cardiology Outpatients

Auscultation While Standing: A Basic and Reliable Method to Rule Out a Pathologic Heart Murmur in Children

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