Ahuja Vasudha, Kini Priyanka, Nileshwar Anitha
Department of Anaesthesiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Indian J Anaesth. 2022 Sep;66(9):625-630. doi: 10.4103/ija.ija_305_22. Epub 2022 Sep 20.
An electronic stethoscope with an inbuilt phonocardiogram is a potentially useful tool for paediatric cardiac evaluation in a resource-limited setting. We aimed to compare the acoustic and electronic stethoscopes with respect to the detection of murmurs as compared to the transthoracic echocardiogram (TTE).
This was an observational study. Fifty children aged 0-12 years with congenital heart diseases (CHDs) and 50 without CHD scheduled for echocardiography were examined using both stethoscopes. The findings were corroborated with clinical findings and compared with the echocardiography report.
Among the 50 cases without CHD, no murmur was detected using either of the stethoscopes. This was in agreement with TTE findings. The calculated specificity of both stethoscopes was 100%. Amongst the 50 cases with CHD, the electronic stethoscope picked up murmurs in 32 cases and missed 18 cases. The acoustic stethoscope picked up murmurs in 29 cases and missed 21 cases. Thus, the sensitivity of electronic and acoustic stethoscopes as compared to TTE was calculated to be 64% and 58%, respectively. The positive predictive value of the electronic stethoscope as compared to TTE was 100% while the negative predictive value was 73%. The kappa statistic was 0.93 suggesting agreement in 93%. Mc-Nemar's test value was 0.24 suggesting that the electronic stethoscope did not offer any advantage over the acoustic stethoscope for the detection of CHD in children.
A comparison of the electronic stethoscope with an acoustic stethoscope suggests that the rate of detection of CHD with both stethoscopes is similar and echocardiography remains the gold standard.
带有内置心音图的电子听诊器在资源有限的环境中对儿科心脏评估而言是一种潜在的有用工具。我们旨在比较声学听诊器和电子听诊器与经胸超声心动图（TTE）相比在杂音检测方面的情况。
这是一项观察性研究。使用两种听诊器对50名患有先天性心脏病（CHD）的0至12岁儿童和50名未患CHD且计划进行超声心动图检查的儿童进行了检查。研究结果与临床发现相互印证，并与超声心动图报告进行了比较。
在50例未患CHD的病例中，两种听诊器均未检测到杂音。这与TTE的检查结果一致。两种听诊器计算得出的特异性均为100%。在50例患有CHD的病例中，电子听诊器检测到32例杂音，漏诊18例。声学听诊器检测到29例杂音，漏诊21例。因此，与TTE相比，电子听诊器和声学听诊器的敏感性分别计算为64%和58%。与TTE相比，电子听诊器的阳性预测值为100%，而阴性预测值为73%。kappa统计量为0.93，表明一致性为93%。Mc-Nemar检验值为0.24，表明在检测儿童CHD方面，电子听诊器相比声学听诊器并无优势。
电子听诊器与声学听诊器的比较表明，两种听诊器对CHD的检出率相似，超声心动图仍是金标准。
