Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-26T16:29:24.715Z Has data issue: false hasContentIssue false
  • English
  • Français

Computer-aided auscultation of murmurs in children: evaluation of commercially available software

Published online by Cambridge University Press:  20 January 2016

Cecilia Lee ,
Kathryn N. Rankin ,
Kevin J. Zuo  and
Andrew S. Mackie
Cecilia Lee
Affiliation:
Stollery Children’s Hospital, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Alberta, Canada
Kathryn N. Rankin
Affiliation:
Department of Pediatrics, University of Alberta, Alberta, Canada
Kevin J. Zuo
Affiliation:
Stollery Children’s Hospital, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Alberta, Canada
Andrew S. Mackie*
Affiliation:
Stollery Children’s Hospital, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Alberta, Canada Department of Public Health Sciences, University of Alberta, Alberta, Canada
*
Correspondence to: Dr A. Mackie, Division of Cardiology, Stollery Children’s Hospital, 4C2 Walter C. Mackenzie Center, 8440-112th St. NW, Edmonton, Alberta, Canada T6G 2B7. Tel: +(780) 407-8361; Fax: +(780) 407-3954; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Heart murmurs are common in children and may represent congenital or acquired cardiac pathology. Auscultation is challenging and many primary-care physicians lack the skill to differentiate innocent from pathologic murmurs. We sought to determine whether computer-aided auscultation (CardioscanTM) identifies which children require referral to a cardiologist.

Methods

We consecutively enrolled children aged between 0 and 17 years with a murmur, innocent or pathologic, being evaluated in a tertiary-care cardiology clinic. Children being evaluated for the first time and patients with known cardiac pathology were eligible. We excluded children who had undergone cardiac surgery previously or were unable to sit still for auscultation. CardioscanTM auscultation was performed in a quiet room with the subject in the supine position. The sensitivity and specificity of a potentially pathologic murmur designation by CardioscanTM – that is, requiring referral – was determined using echocardiography as the reference standard.

Results

We enrolled 126 subjects (44% female) with a median age of 1.7 years, with 93 (74%) having cardiac pathology. The sensitivity and specificity of a potentially pathologic murmur determination by CardioscanTM for identification of cardiac pathology were 83.9 and 30.3%, respectively, versus 75.0 and 71.4%, respectively, when limited to subjects with a heart rate of 50–120 beats per minute. The combination of a CardioscanTM potentially pathologic murmur designation or an abnormal electrocardiogram improved sensitivity to 93.5%, with no haemodynamically significant lesions missed.

Conclusions

Sensitivity of CardioscanTM when interpreted in conjunction with an abnormal electrocardiogram was high, although specificity was poor. Re-evaluation of computer-aided auscultation will remain necessary as advances in this technology become available.

Keywords

Heart murmurchildrenauscultationcomputer analysissensitivityspecificity
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 7 , October 2016 , pp. 1359 - 1364
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Wong, KK, Barker, AP, Warren, AE. Paediatricians’ validation of learning objectives in paediatric cardiology. Paediatr Child Health 2005; 10: 95–99.Google Scholar
2. Haney, I, Ipp, M, Feldman, W, McCrindle, BW. Accuracy of clinical assessment of heart murmurs by office based (general practice) paediatricians. Arch Dis Child 1999; 81: 409–412.CrossRefGoogle ScholarPubMed
3. Roy, D, Sargeant, J, Gray, J, Hoyt, B, Allen, M, Fleming, M. Helping family physicians improve their cardiac auscultation skills with an interactive CD-ROM. J Contin Educ Health Prof 2002; 22: 152–159.Google Scholar
4. Germanakis, I, Petridou, ET, Varlamis, G, Matsoukis, IL, Papadopoulou-Legbelou, K, Kalmanti, M. Skills of primary healthcare physicians in paediatric cardiac auscultation. Acta Paediatr 2013; 102: e74–e78.Google Scholar
5. Yi, MS, Kimball, TR, Tsevat, J, Mrus, JM, Kotagal, UR. Evaluation of heart murmurs in children: cost-effectiveness and practical implications. J Pediatr 2002; 141: 504–511.CrossRefGoogle ScholarPubMed
6. Danford, DA, Nasir, A, Gumbiner, C. Cost assessment of the evaluation of heart murmurs in children. Pediatrics 1993; 91: 365–368.CrossRefGoogle ScholarPubMed
7. Lai, WW, Geva, T, Shirali, GS, et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr 2006; 19: 1413–1430.CrossRefGoogle ScholarPubMed
8. Mitchell, SC, Korones, SB, Berendes, HW. Congenital heart disease in 56,109 births. Incidence and natural history. Circulation 1971; 43: 323–332.Google Scholar
9. Jaeschke, R, Guyatt, G, Lijmer, J. Chapter 1C2: diagnostic tests. In Gordon G, Drummond R, (eds). Users’ Guide to the Medical Literature. AMA Press, Chicago, 2002: 121–140.Google Scholar
10. Newburger, JW, Rosenthal, A, Williams, RG, Fellows, K, Miettinen, OS. Noninvasive tests in the initial evaluation of heart murmurs in children. N Engl J Med 1983; 308: 61–64.Google Scholar
11. Smythe, JF, Teixeira, OH, Vlad, P, Demers, PP, Feldman, W. Initial evaluation of heart murmurs: are laboratory tests necessary? Pediatrics 1990; 86: 497–500.Google Scholar
12. Geva, T, Hegesh, J, Frand, M. Reappraisal of the approach to the child with heart murmurs: is echocardiography mandatory? Int J Cardiol 1988; 19: 107–113.Google Scholar
13. McCrindle, BW, Shaffer, KM, Kan, JS, Zahka, KG, Rowe, SA, Kidd, L. Cardinal clinical signs in the differentiation of heart murmurs in children. Arch Pediatr Adolesc Med 1996; 150: 169–174.Google Scholar
14. Tavel, ME, Katz, H. Usefulness of a new sound spectral averaging technique to distinguish an innocent systolic murmur from that of aortic stenosis. Am J Cardiol 2005; 95: 902–904.Google Scholar
15. Watrous, RL, Thompson, WR, Ackerman, SJ. The impact of computer-assisted auscultation on physician referrals of asymptomatic patients with heart murmurs. Clin Cardiol 2008; 31: 79–83.Google Scholar
16. DeGroff, CG, Bhatikar, S, Hertzberg, J, Shandas, R, Valdes-Cruz, L, Mahajan, RL. Artificial neural network – based method of screening heart murmurs in children. Circulation 2001; 103: 2711–2716.CrossRefGoogle ScholarPubMed
17. Sepehri, AA, Hancq, J, Dutoit, T, Gharehbaghi, A, Kocharian, A, Kiani, A. Computerized screening of children congenital heart diseases. Comput Methods Programs Biomed 2008; 92: 186–192.Google Scholar
18. Noponen, A-, Lukkarinen, S, Angerla, A, Sepponen, R. Phono-spectrographic analysis of heart murmur in children. BMC Pediatr 2007; 7: 23.CrossRefGoogle ScholarPubMed