title: Accuracy of clinical assessment of heart murmurs by office based (general practice) paediatricians.
abstract: OBJECTIVE
  To determine the diagnostic accuracy of physical examination by office based (general practice) paediatricians in the evaluation of heart murmurs.
  
  
  METHODS
  Each of 30 office based paediatricians blindly examined a random sample of children with murmurs (43% of which were pathological). Sensitivity and specificity were calculated and were related to paediatricians' characteristics.
  
  
  RESULTS
  Mean (SD) sensitivity was 82 (24)% with a mean specificity of 72 (24)% in differentiating pathological from innocent murmurs, with further investigations requested for 54% of assessments. The addition of a referral strategy would have increased mean sensitivity to 87 (20)% and specificity to 98 (8)%. Diagnostic accuracy was not significantly related to the paediatricians' age, education or practice characteristics, but was related to referral 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 misdiagnosis.
authors.affiliation: Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Haney
authors.forename: M
authors.initials: M
authors.lastname: Ipp
authors.forename: W
authors.initials: W
authors.lastname: Feldman
authors.forename: B W
authors.initials: BW
authors.lastname: McCrindle
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D004502:Education, Medical, Continuing; D004522:Educational Status; D005260:Female; D006337:Heart Murmurs / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010372:Pediatrics / Q000193:education / Q000592:standards*; D010808:Physical Examination / Q000592:standards*; D012017:Referral and Consultation; D012680:Sensitivity and Specificity