Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India.
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
BMJ Paediatr Open. 2022 Aug;6(1). doi: 10.1136/bmjpo-2022-001595.
It is widely perceived that the value of physical examination in paediatric cardiology has diminished with the increasing availability of echocardiography. The accuracy of physical examination of cardiovascular system in children has not been systematically tested.
This is a cross-sectional, diagnostic accuracy study from the paediatric cardiology clinic of a tertiary referral hospital in South India. A total of 545 children with 5 common cardiac conditions were included-normal heart, atrial septal defect, patent ductus arteriosus, ventricular septal defect (VSD) and VSD with pulmonic stenosis. Physical examination was documented by a paediatric cardiology fellow and a consultant who were blinded to previous investigations and to each other. The accuracy of physical examination of the fellow and the consultant was determined for each patient group by comparing with echocardiography. Interobserver agreement was calculated using kappa statistics.
Physical examination differentiated normal hearts from abnormal with an accuracy of 95.0% for fellows and 96.3% for consultants. For all abnormal hearts, the results for fellows and consultants, respectively, were as follows: sensitivity: 94.3%, 94.9%, specificity: 96.2%, 98.6%, accuracy: 95.0%, 96.3%, positive likelihood ratio: 24.8, 66.4 and negative likelihood ratio: 0.06, 0.05. There was good agreement between fellows and consultant for all patient groups (kappa: 0.72-1), except for large VSD (kappa: 0.232). Younger age and haemodynamically insignificant lesions were associated with incorrect diagnosis.
This study underscores the utility of clinical examination in initial screening for commonly encountered congenital cardiac conditions even in the current era of echocardiography.
人们普遍认为，随着超声心动图的广泛应用，体格检查在儿科心脏病学中的价值已经降低。儿童心血管系统体格检查的准确性尚未得到系统测试。
这是一项来自印度南部一家三级转诊医院儿科心脏病学诊所的横断面、诊断准确性研究。共有 545 名患有 5 种常见心脏病的儿童被纳入研究，包括正常心脏、房间隔缺损、动脉导管未闭、室间隔缺损 (VSD) 和 VSD 合并肺动脉瓣狭窄。体格检查由一名儿科心脏病学研究员和一名顾问记录，他们对先前的检查和彼此都不知情。通过与超声心动图比较，确定研究员和顾问对每个患者组体格检查的准确性。使用 Kappa 统计计算观察者间一致性。
体格检查可将正常心脏与异常心脏区分开来，研究员的准确率为 95.0%，顾问的准确率为 96.3%。对于所有异常心脏，研究员和顾问的结果分别如下：敏感性：94.3%、94.9%，特异性：96.2%、98.6%，准确性：95.0%、96.3%，阳性似然比：24.8、66.4，阴性似然比：0.06、0.05。除了大型 VSD（kappa：0.232）外，研究员和顾问在所有患者组之间的一致性都很好（kappa：0.72-1）。年龄较小和血流动力学无意义的病变与错误诊断有关。
即使在当前超声心动图时代，本研究强调了临床检查在最初筛查常见先天性心脏病中的作用。
