Authors:
Roberts KV, Brown AD, Maguire GP, Atkinson DN, Carapetis JR
Authors notes:
Medical Journal of Australia. 2013;199(3):196-199
Keywords:
Rheumatic heart disease, auscultatory screening, detection, echocardiography, congenital abornomalities
Abstract:
To evaluate the utility of auscultatory screening for detecting echocardiographically confirmed rheumatic heart disease (RHD) in high-risk children in the Northern Territory, Australia.
Of the 1015 children screened, 34 (3.3%) had abnormalities identified on their echocardiogram; 24 met echocardiographic criteria for definite or borderline RHD, and 10 had isolated congenital anomalies.
Detection of any murmur by a nurse had a sensitivity of 47.1%, specificity of 74.8% and positive predictive value (PPV) of 6.1%.
Doctor identification of any murmur had 38.2% sensitivity, 75.1% specificity and 5.1% PPV, and the corresponding values for doctor detection of suspicious or pathological murmurs were 20.6%, 92.2% and 8.3%.
For all auscultation approaches, negative predictive value was more than 97%, but the majority of participants with cardiac abnormalities were not identified.
The results were no different when only definite RHD and congenital abnormalities were considered as true cases.
Sensitivity and positive predictive value of cardiac auscultation compared with echocardiography is poor, regardless of the expertise of the auscultator.
Although negative predictive value is high, most cases of heart disease were missed by auscultation, suggesting that cardiac auscultation should no longer be used to screen for RHD in high-risk schoolchildren in Australia.