title: Pulmonary stenosis: defect-specific diagnostic accuracy of heart murmurs in children.
abstract: OBJECTIVE
  To determine the accuracy of expert examination for pulmonary stenosis (PS) among children with murmur.
  
  
  METHODS
  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 mild or severe. After echocardiography, PS was categorized by severity with peak systolic flow velocity. Receiver operating characteristic curves described 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). Specific difficulties in discrimination of PS from small ventricular septal defect, aortic valve disease, atrial septal defect, and innocent murmur were identified. All cases of severe PS in which PS was suspected were thought possibly severe.
  
  
  CONCLUSIONS
  Although expert clinical examination is highly accurate for distinguishing PS from non-PS cardiac murmurs in pediatric patients, it is imperfect.
authors.affiliation: Joint Section of Pediatric Cardiology, University of Nebraska Medical Center and Creighton University School of Medicine, Children's Hospital, Omaha, Nebraska, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Danford
authors.forename: K J
authors.initials: KJ
authors.lastname: Salaymeh
authors.forename: A B
authors.initials: AB
authors.lastname: Martin
authors.forename: S E
authors.initials: SE
authors.lastname: Fletcher
authors.forename: C H
authors.initials: CH
authors.lastname: Gumbiner
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004452:Echocardiography; D005189:False Positive Reactions; D005260:Female; D006337:Heart Murmurs / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D011666:Pulmonary Valve Stenosis / Q000145:classification / Q000150:complications / Q000175:diagnosis*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index