Pulmonary stenosis: Defect-specific diagnostic accuracy of heart murmurs in children

Objective: To determine the accuracy of expert examination for pulmonary st enosis (PS) among children with murmur. Study design: Five hundred twenty-one consecutive, previously unevaluated, pediatric patients were enrolled. The investigators prospectively recorded their diagnosis and level of confidence, categorizing any PS suspected as m ild or severe. After echocardiography, PS was categorized by severity with peak systolic flow velocity. Receiver operating characteristic curves descr ibed accuracy of clinical examination. Results: Sixty-two patients had PS (mild, 29; moderate, 27; and severe, 6). Receiver operator characteristic curve areas were: total, 0.834 +/- 0.033; mild, 0.862 +/- 0.044; and moderate to severe, 0.809 +/- 0.046 (P =.20). S pecific difficulties in discrimination of PS from small ventricular septal defect, aortic valve disease, atrial septal defect, and innocent murmur wer e identified. All cases of severe PS in which PS was suspected were thought possibly severe. Conclusions: Although expert clinical examination is highly accurate for di stinguishing PS from non-PS cardiac murmurs in pediatric patients, it is im perfect.