Diagnostic value of the physical examination and electrocardiogram in the initial evaluation of children with heart murmur.

Objective. - To investigate the diagnostic value of the physical examinatio n and electrocardiogram in the evaluation of heart murmur in new patients r eferred to the pediatric cardiologist. Method - From I April to 30 September 1998, all consecutive patients referr ed to the pediatric cardiology clinic for evaluation of heart murmur were i ncluded They were prospectively categorized with no heart disease, possible heart disease or definite heart disease based on history and physical exam ination. They then underwent electrocardiogram with which the diagnosis was reevaluated by the pediatric cardiologist. Lastly, a doppler-echocardiogra phy was systematically performed Results. - in 120 children aged four days to 14 years (median: ten months), 72 (60%) showed abnormalities on doppler-echocardiography and 48 (40%) no heart disease. After physical examination, 52 patients were categorized wit h no heart disease: 45 patients had a normal doppler-echocardiography; in t hree of them, the diagnosis was incorrectly modified to possible heart dise ase on the basis of the electrocardiogram. In the other seven children, the electrocardiogram was normal and the doppler-echocardiography revealed min or (n = 5) or moderate (n = 2) heart defects. Nineteen patients were suspec ted of having possible heart disease, no diagnosis was modified after analy sis of the electrocardiogram and six had normal doppler-echocardiography; 4 9 patients were correctly diagnosed as having definite heart disease. The s ensibility of the physical examination was 90.3%, the specificity was 93.8% , the positive predictive value 95.6% and the negative predictive value 86. 5%. Conclusion. - The electrocardiogram is of no help in the discrimination bet ween heart disease and no heart disease in children referred to the pediatr ic cardiologist for a cardiac murmur The physical examination is able to di fferentiate children with or without heart disease in most of the cases. (C ) 2000 Editions scientifiques et medicales Elsevier SAS.