Screening for congenital heart malformation in child health centres

Background Although screening for congenital heart malformations is part of the child health care programme in several countries, there are very few p ublished evaluations of these activities. This report is concerned with the evaluation of this screening at the Dutch Child Health Centres (CHC). Methods All consecutive patients, aged between 32 days and 4 years, present ed at the Sophia Children's Hospital Rotterdam throughout a period of 2 yea rs, with a congenital heart malformation were included in this study. Paedi atric cardiologists established whether or not these patients were diagnose d after haemodynamic complications had already developed (diagnosed 'too la te'). Parents and CHC-physicians were interviewed in order to establish the screening and detection history. Test properties were established for all patients with a congenital heart malformation (n = 290), intended effects o f screening were established in patients with clinically significant malfor mations (n = 82). Results The sensitivity of the actual screening programme was 0.57 (95% CI: 0.51-0.62), the specificity 0.985 (99% CI: 0,981-0.990) and the predictive value of a positive test result 0.13 (95% CI:0.10-0.19). Sensitivity in a s ubpopulation of patients adequately screened was 0.89 (95% CI:0.74-0.96). A dequately screened patients were less likely to be diagnosed 'too late' tha n inadequately screened patients (odds ratio [OR] = 0.20, 95% CI:0.04-1.05) . The actual risk of being diagnosed 'too late' in the study-population (48 %) was only slightly less than the estimated risk for patients not exposed to CHC-screening (58%, 95% CI:43%-72%). Adequately screened patients howeve r were at considerably less risk (17%, 95% CI:4%-48%). Conclusion Screening for congenital heart malformations in CHC contributes to the timely detection of these disorders. The actual yield, however, is f ar from optimal, and the screening programme should be improved.