Accuracy of clinical assessment of heart murmurs by office based (general practice) paediatricians

Aim-To determine the diagnostic accuracy of physical examination by office based (general practice) paediatricians in the evaluation of heart murmurs. Design-Each of 30 office based paediatricians blindly examined a random sam ple of children with murmurs (43% of which were pathological). Sensitivity and specificity were calculated and were related to paediatricians' charact eristics. Results-Mean (SD) sensitivity was 82 (24)% with a mean specificity of 72 (2 4)% in differentiating pathological from innocent murmurs, with further inv estigations requested for 54% of assessments. The addition of a referral st rategy would have increased mean sensitivity to 87 (20)% and specificity to 98 (8)%. Diagnostic accuracy was not significantly related to the paediatr icians' age, education or practice characteristics, but was related to refe rral practices and confidence in assessment. Conclusions-Diagnostic accuracy of clinical assessment of heart :murmurs by office based paediatricians is suboptimal, and educational strategies are needed to improve accuracy and reduce unnecessary referrals and misdiagnosi s.