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Computer-aided auscultation of murmurs in children: evaluation of commercially available software

Published online by Cambridge University Press:  20 January 2016

Cecilia Lee ,
Kathryn N. Rankin ,
Kevin J. Zuo  and
Andrew S. Mackie
Cecilia Lee
Affiliation:
Stollery Children’s Hospital, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Alberta, Canada
Kathryn N. Rankin
Affiliation:
Department of Pediatrics, University of Alberta, Alberta, Canada
Kevin J. Zuo
Affiliation:
Stollery Children’s Hospital, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Alberta, Canada
Andrew S. Mackie*
Affiliation:
Stollery Children’s Hospital, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Alberta, Canada Department of Public Health Sciences, University of Alberta, Alberta, Canada
*
Correspondence to: Dr A. Mackie, Division of Cardiology, Stollery Children’s Hospital, 4C2 Walter C. Mackenzie Center, 8440-112th St. NW, Edmonton, Alberta, Canada T6G 2B7. Tel: +(780) 407-8361; Fax: +(780) 407-3954; E-mail: andrew.mackie@ualberta.ca
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Abstract

Background

Heart murmurs are common in children and may represent congenital or acquired cardiac pathology. Auscultation is challenging and many primary-care physicians lack the skill to differentiate innocent from pathologic murmurs. We sought to determine whether computer-aided auscultation (CardioscanTM) identifies which children require referral to a cardiologist.

Methods

We consecutively enrolled children aged between 0 and 17 years with a murmur, innocent or pathologic, being evaluated in a tertiary-care cardiology clinic. Children being evaluated for the first time and patients with known cardiac pathology were eligible. We excluded children who had undergone cardiac surgery previously or were unable to sit still for auscultation. CardioscanTM auscultation was performed in a quiet room with the subject in the supine position. The sensitivity and specificity of a potentially pathologic murmur designation by CardioscanTM – that is, requiring referral – was determined using echocardiography as the reference standard.

Results

We enrolled 126 subjects (44% female) with a median age of 1.7 years, with 93 (74%) having cardiac pathology. The sensitivity and specificity of a potentially pathologic murmur determination by CardioscanTM for identification of cardiac pathology were 83.9 and 30.3%, respectively, versus 75.0 and 71.4%, respectively, when limited to subjects with a heart rate of 50–120 beats per minute. The combination of a CardioscanTM potentially pathologic murmur designation or an abnormal electrocardiogram improved sensitivity to 93.5%, with no haemodynamically significant lesions missed.

Conclusions

Sensitivity of CardioscanTM when interpreted in conjunction with an abnormal electrocardiogram was high, although specificity was poor. Re-evaluation of computer-aided auscultation will remain necessary as advances in this technology become available.

Keywords

Heart murmurchildrenauscultationcomputer analysissensitivityspecificity
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 7 , October 2016 , pp. 1359 - 1364
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Copyright
© Cambridge University Press 2016 

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