Discigil Guzel, Aydogdu Ayvaz, Gemalmaz Ayfer, Gurel F Serdar, Basak Okay
Department of Family Medicine, Faculty of Medicine, Adnan Menderes University, 09100 Aydin, Turkey.
Int J Family Med. 2010;2010:370731. doi: 10.1155/2010/370731. Epub 2010 Nov 7.
Aim. Heart murmur is common in children, and it is one of the main reasons for referral among children in primary care. The aim of this study is to evaluate agreement and consistency of normal, innocent, and pathologic murmur decision between academic family physicians and academic pediatric cardiologist. Methods. Seven hundred fifteen primary school children were examined by family physicians and paediatric cardiologist. Auscultatory examination was performed. Intensity, frequency, duration, quality, location, and radiation of the murmur were described if present. Agreement of normal, innocent, and pathologic murmur classification decision between family physician and paediatric cardiologist was analyzed by using kappa statistic. Results. Normal, innocent and pathologic murmurs were reported for 419, 228, and 54 children in family physicians' reports, respectively. Paediatric cardiologist agreed on 383 (91.4%) children as normal, 191 (83.7%) children having innocent murmur, and 19 (35.2%) children having pathologic murmur among family physician's reports. There was good consistency between family physicians and paediatric cardiologist (κ value = 0.679, 95% CI 0.630-0.727, P < .001). They agreed on the majority of normal and innocent murmur decisions. However family physicians reported pathologic murmur more frequently. Conclusion. Cardiac auscultatory skills of academic family physicians may be concordant with paediatric cardiologist.
目的。心脏杂音在儿童中很常见，是基层医疗中儿童转诊的主要原因之一。本研究的目的是评估学术家庭医生和学术儿科心脏病专家在正常、无害和病理性杂音判断上的一致性和连贯性。方法。715名小学生接受了家庭医生和儿科心脏病专家的检查。进行了听诊检查。如有杂音，描述其强度、频率、持续时间、性质、位置和传导情况。使用kappa统计分析家庭医生和儿科心脏病专家在正常、无害和病理性杂音分类判断上的一致性。结果。家庭医生报告中分别有419名、228名和54名儿童存在正常、无害和病理性杂音。儿科心脏病专家在家庭医生报告中，认同383名（91.4%）儿童为正常，191名（83.7%）儿童有无害杂音，19名（35.2%）儿童有病理杂音。家庭医生和儿科心脏病专家之间存在良好的一致性（κ值 = 0.679，95%CI 0.630 - 0.727，P <.001）。他们在大多数正常和无害杂音判断上达成一致。然而，家庭医生报告病理性杂音更为频繁。结论。学术家庭医生的心脏听诊技能可能与儿科心脏病专家一致。
