Menzies School of Health Research, Darwin, NT.
Med J Aust. 2013 Aug 5;199(3):196-9. doi: 10.5694/mja13.10520.
To evaluate the utility of auscultatory screening for detecting echocardiographically confirmed rheumatic heart disease (RHD) in high-risk children in the Northern Territory, Australia.
Cross-sectional screening survey.
Twelve rural and remote communities in the NT between September 2008 and June 2010.
1015 predominantly Indigenous schoolchildren aged 5-15 2013s.
All children underwent transthoracic echocardiography, using a portable cardiovascular ultrasound machine, and cardiac auscultation by a doctor and a nurse. Sonographers and auscultators were blinded to each others' findings and the clinical history of the children. Echocardiograms were reported offsite, using a standardised protocol, by cardiologists who were also blinded to the clinical findings.
Presence of a cardiac murmur as identified by nurses (any murmur) and doctors (any murmur, and "suspicious" or "pathological" murmurs), compared with echocardiogram findings. RHD was defined according to the 2012 World Heart Federation criteria for echocardiographic diagnosis of RHD.
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.
评估听诊筛查在澳大利亚北部地区高危儿童中检测经超声心动图证实的风湿性心脏病（RHD）的效用。
横断面筛查调查。
2008 年 9 月至 2010 年 6 月期间，澳大利亚北部 12 个农村和偏远社区。
1015 名主要为土著的 5-15 岁学龄儿童。
所有儿童均接受经胸超声心动图检查，使用便携式心血管超声机，并由医生和护士进行心脏听诊。超声技师和听诊师对彼此的发现以及儿童的临床病史均不知情。超声心动图报告由心脏科医生在现场外使用标准化协议进行，这些医生也对临床发现不知情。
护士（任何杂音）和医生（任何杂音和“可疑”或“病理性”杂音）识别的心脏杂音与超声心动图结果的比较。RHD 根据 2012 年世界心脏联合会用于超声心动图诊断 RHD 的标准进行定义。
在 1015 名接受筛查的儿童中，34 名（3.3%）的超声心动图检查发现异常；24 名符合超声心动图确诊或临界 RHD 的标准，10 名患有孤立性先天性异常。护士识别任何杂音的敏感性为 47.1%，特异性为 74.8%，阳性预测值（PPV）为 6.1%。医生识别任何杂音的敏感性为 38.2%，特异性为 75.1%，PPV 为 5.1%，而医生检测可疑或病理性杂音的敏感性、特异性和 PPV 分别为 20.6%、92.2%和 8.3%。对于所有听诊方法，阴性预测值均超过 97%，但大多数心脏异常的参与者并未被识别。仅考虑确诊 RHD 和先天性异常作为真实病例，结果也没有差异。
听诊与超声心动图相比，敏感性和阳性预测值均较差，而与听诊者的专业知识无关。尽管阴性预测值较高，但听诊法漏诊了大多数心脏病病例，提示在澳大利亚高危学龄儿童中，不应再使用心脏听诊法筛查 RHD。
