Castello-Herbreteau B, Vaillant M C, Magontier N, Pottier J M, Blond M H, Chantepie A
Unité de cardiologie pédiatrique, hôpital Clocheville, Tours, France.
Arch Pediatr. 2000 Oct;7(10):1041-9. doi: 10.1016/s0929-693x(00)00311-0.
To investigate the diagnostic value of the physical examination and electrocardiogram in the evaluation of heart murmur in new patients referred to the pediatric cardiologist.
From 1 April to 30 September 1998, all consecutive patients referred to the pediatric cardiology clinic for evaluation of heart murmur were included. They were prospectively categorized with no heart disease, possible heart disease or definite heart disease based on history and physical examination. They then underwent electrocardiogram with which the diagnosis was reevaluated by the pediatric cardiologist. Lastly, a doppler-echocardiography was systematically performed.
In 120 children aged four days to 14 years (median: ten months), 72 (60%) showed abnormalities on doppler-echocardiography and 48 (40%) no heart disease. After physical examination, 52 patients were categorized with no heart disease: 45 patients had a normal doppler-echocardiography; in three of them, the diagnosis was incorrectly modified to possible heart disease on the basis of the electrocardiogram. In the other seven children, the electrocardiogram was normal and the doppler-echocardiography revealed minor (n = 5) or moderate (n = 2) heart defects. Nineteen patients were suspected of having possible heart disease, no diagnosis was modified after analysis of the electrocardiogram and six had normal doppler-echocardiography; 49 patients were correctly diagnosed as having definite heart disease. The sensibility of the physical examination was 90.3%, the specificity was 93.8%, the positive predictive value 95.6% and the negative predictive value 86.5%.
The electrocardiogram is of no help in the discrimination between heart disease and no heart disease in children referred to the pediatric cardiologist for a cardiac murmur. The physical examination is able to differentiate children with or without heart disease in most of the cases.
探讨体格检查和心电图在评估转诊至儿科心脏病专家处的新患者心脏杂音中的诊断价值。
纳入1998年4月1日至9月30日期间所有连续转诊至儿科心脏病门诊以评估心脏杂音的患者。根据病史和体格检查，将他们前瞻性地分为无心脏病、可能有心脏病或确诊有心脏病三类。然后他们接受心电图检查，儿科心脏病专家据此重新评估诊断。最后，系统地进行多普勒超声心动图检查。
120名年龄在4天至14岁（中位数：10个月）的儿童中，72名（60%）在多普勒超声心动图检查中显示异常，48名（40%）无心脏病。体格检查后，52名患者被归类为无心脏病：45名患者的多普勒超声心动图检查正常；其中3名患者，基于心电图，诊断被错误地改为可能有心脏病。在另外7名儿童中，心电图正常，多普勒超声心动图检查发现轻微（n = 5）或中度（n = 2）心脏缺陷。19名患者被怀疑可能有心脏病，心电图分析后诊断未改变，6名患者的多普勒超声心动图检查正常；49名患者被正确诊断为确诊有心脏病。体格检查的敏感性为90.3%，特异性为93.8%，阳性预测值为95.6%，阴性预测值为86.5%。
对于因心脏杂音转诊至儿科心脏病专家处的儿童，心电图无助于区分有无心脏病。在大多数情况下，体格检查能够区分有无心脏病的儿童。
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