Sensitivity of clinical assessment in term neonates by general pediatric residents.
OBJECTIVE
To determine the accuracy of physical examination in detecting congenital heart diseases by pediatric residents and identify risk factors of congenital heart diseases.


METHODS
Five hundred term infants (GA > or = 37wks) who were born at Phramongkutklao Hospital from July 1st, 1999 to June 3th, 2000 were examined by pediatric residents and pediatric cardiologists within the first week of life. The echocardiography was performed in all 500 infants for definite diagnosis. The accuracy of physical examination was determined by comparing with echocardiographic finding and presented as sensitivity and specificity.


RESULTS
Congenital heart diseases were found in 18 of 500 term infants (3.6%). The physical examination by pediatric residents and pediatric cardiologists showeds a sensitivity of 39% and 94% and the specificity of 98% and 97%, respectively. After excluding spontaneously closed PDA within 2 weeks, the first and second most common congenital heart diseases in infants were Ventricular septum defect (VSD) (44%) and Patent ductus arteriosus (PDA) (33%). The positive other cardiovascular signs, such as cyanosis or abnormal pulses with heart murmur were significantly associated to diagnosis of congenital heart diseases.


CONCLUSIONS
Although echocardiography is the major tool to determine the definite diagnosis, most congenital heart diseases can be well detected during physical examination by skilled physicians. As a result, the value of physical examination of the cardiovascular system should be emphasized in training general pediatricians concerning lower costs and early detection of congenital heart diseases.
Gengsakul
Aungkana
A
Cardiology Unit, Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand. gengsakul@yahoo.com
Tuntrakool
Chalermkiet
C
Kunathai
Suriporn
S
Haupara
Santa
S
Chamnanvanakij
Sangkae
S
D002983:Clinical Competence; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D007396:Internship and Residency; D008297:Male; D010372:Pediatrics / Q000193:education; D010808:Physical Examination; D012307:Risk Factors; D012680:Sensitivity and Specificity