Nh. Birkebaek et al., Chest roentgenogram in the evaluation of heart defects in asymptomatic infants and children with a cardiac murmur: Reproducibility and accuracy, PEDIATRICS, 103(2), 1999, pp. E151-E154
Objectives. To evaluate the reproducibility and the accuracy of pediatric r
adiologists' assessments of chest radiographs with respect to the presence
or absence of heart defects in children with an asymptomatic heart murmur.
Design. Ninety-eight children, ages 1 month to 15 years (median, 30.1 month
s), referred for evaluation of a heart murmur were consecutively included.
They all had a standard chest radiograph and a color Doppler echocardiograp
h (CDE) performed. Six specialists in pediatric radiology evaluated the che
st radiographs independently on two occasions 6 months apart. The radiologi
sts were asked to classify each set of films into one of two categories: he
art disease or no heart disease. The outcome of the CDE was considered the
definite diagnosis. kappa statistics were used to analyze the reproducibili
ty of the radiologic assessments. Sensitivity, specificity, and the predict
ive value of a positive and a negative test were used for evaluation of the
accuracy of the radiologic assessments.
Results. Mean intra- and interobserver kappa values were all <0.6, and the
majority were <0.4. Mean sensitivity was 0.3 (range: 0.17-0.52), mean predi
ctive value of a positive test was 0.4, implying that 60% of the positive a
ssessments were falsely positive. Mean specificity was 0.86 (range: 0.75-0.
93) and the mean predictive value of a negative test was 0.80 implying that
20% of the negative assessments were falsely negative.
Conclusion We found a low reproducibility, as well as a low accuracy, of th
e radiologic assessments of the chest radiographs of children with an asymp
tomatic heart murmur with respect to the presence or absence of heart disea
se. A false-positive radiologic assessment of the chest radiograph with res
pect to heart defects causes unnecessary anxiety and further examinations,
whereas a false-negative assessment might result in omission of relevant in
vestigations and proper identification of the heart defect. We cannot recom
mend the use of chest radiographs in the initial evaluation of the asymptom
atic child with a heart murmur. If a heart defect cannot be excluded by cli
nical examination a CDE must be performed.