title: [Diagnostic value of physical examination and electrocardiogram in the initial evaluation of heart murmurs in children].
abstract: OBJECTIVE
  To investigate the diagnostic value of the physical examination and electrocardiogram in the evaluation of heart murmur in new patients referred to the pediatric cardiologist.
  
  
  METHODS
  From 1 April to 30 September 1998, all consecutive patients referred to the pediatric cardiology clinic for evaluation of heart murmur were included. They were prospectively categorized with no heart disease, possible heart disease or definite heart disease based on history and physical examination. They then underwent electrocardiogram with which the diagnosis was reevaluated by the pediatric cardiologist. Lastly, a doppler-echocardiography 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 with no heart disease: 45 patients had a normal doppler-echocardiography; in three of them, the diagnosis was incorrectly modified to possible heart disease on the basis of the electrocardiogram. In the other seven children, the electrocardiogram was normal and the doppler-echocardiography revealed minor (n = 5) or moderate (n = 2) heart defects. Nineteen patients were suspected of having possible heart disease, no diagnosis was modified after analysis of the electrocardiogram and six had normal doppler-echocardiography; 49 patients were correctly diagnosed as having definite heart disease. The sensibility 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%.
  
  
  CONCLUSIONS
  The electrocardiogram is of no help in the discrimination between heart disease and no heart disease in children referred to the pediatric cardiologist for a cardiac murmur. The physical examination is able to differentiate children with or without heart disease in most of the cases.
authors.affiliation: Unité de cardiologie pédiatrique, hôpital Clocheville, Tours, France.
authors.forename: B
authors.initials: B
authors.lastname: Castello-Herbreteau
authors.forename: M C
authors.initials: MC
authors.lastname: Vaillant
authors.forename: N
authors.initials: N
authors.lastname: Magontier
authors.forename: J M
authors.initials: JM
authors.lastname: Pottier
authors.forename: M H
authors.initials: MH
authors.lastname: Blond
authors.forename: A
authors.initials: A
authors.lastname: Chantepie
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003627:Data Interpretation, Statistical; D003937:Diagnosis, Differential; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D005260:Female; D006326:Heart Auscultation; D006331:Heart Diseases / Q000175:diagnosis*; D006337:Heart Murmurs / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012737:Sex Factors