title: Echocardiographic screening for congenital heart disease: a randomized study.
abstract: OBJECTIVE
  To assess the effectiveness and potential cost of an echocardiographic screening program for congenital heart disease (CHD).
  
  
  METHODS
  Between 01/11/94 and 28/02/98 there were 9697 deliveries in The Royal Maternity Hospital Belfast. Mothers were randomized before delivery. 4875 infants were allocated to the scan group, while 4822 were assigned to clinical assessment alone. High-risk infants were considered separately. Cases of CHD detected before hospital discharge were documented. The annual cost of screening was estimated and the time to accurate diagnosis in each group was assessed.
  
  
  RESULTS
  During the study 124 scan allocated infants and 50 controls were identified as having significant CHD before hospital discharge. With a minimum of 3 years follow-up there were 27 additional late diagnoses in controls and 1 in scanned infants. During a single year of the study the mean time to complete diagnosis was 2 days for scanned cases and 110 in controls. The projected cost of screening for all infants was 22 Pounds/infant for the first year.
  
  
  CONCLUSIONS
  Adding echocardiography to clinical examination greatly enhances early detection of CHD. Although screening is expensive, once established it may reduce the cost of unnecessary outpatient referrals.
authors.affiliation: Department of Pediatric Cardiology, Royal Hospitals, Belfast, U.K.
authors.forename: Andrew
authors.initials: A
authors.lastname: Sands
authors.forename: Brian
authors.initials: B
authors.lastname: Craig
authors.forename: Connor
authors.initials: C
authors.lastname: Mulholland
authors.forename: Christopher
authors.initials: C
authors.lastname: Patterson
authors.forename: James
authors.initials: J
authors.lastname: Dornan
authors.forename: Frank
authors.initials: F
authors.lastname: Casey
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D004452:Echocardiography / Q000191:economics / Q000379:methods; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D009660:Northern Ireland / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D011247:Pregnancy; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000191:economics / Q000379:methods