title: Digital phonocardiography as a screening tool for heart disease in childhood.
abstract: OBJECTIVE
  To evaluate the performance of experienced cardiologists by use of digital phonocardiography for the correct identification of heart disease and innocent murmurs in children.
  
  
  METHODS
  Two independent paediatric cardiologists blindly evaluated 83 digital phonocardiograms obtained from consecutive paediatric cardiology outpatients. Each observer had to document the presence and characteristics of murmurs (intensity, quality, location), the presence of additional abnormal auscultatory findings (systolic click, second heart tone abnormalities) and whether he would recommend echocardiography (ECHO). The accuracy of their diagnoses was tested against the ECG diagnosis within two severity levels of heart disease.
  
  
  RESULTS
  Twenty-three out of 24 cases (95.8%) with moderate-to-severe heart defects and 12 to 13 out of 19 cases (63.2%-68.4%) with trivial-to-mild heart defects were correctly identified by phonocardiography. Additionally, 37 to 38 out of 40 cases (92.5%-95.0%) without ECHO evidence of heart disease were correctly interpreted as having innocent murmurs. The level of agreement between the two observers was substantial regarding their recommendations for ECHO (kappa, kappa=0.83) and in identifying abnormal murmurs (kappa=0.78).
  
  
  CONCLUSIONS
  Evaluation of digital phonocardiography by experienced cardiologists could allow for correct identification of moderate-to-severe forms of heart disease while preventing the majority of children with innocent murmurs from unnecessary referral.
authors.affiliation: Paediatric Cardiology Unit, Department of Paediatrics, University Hospital, Heraklion, Crete, Greece. germjohn@med.uoc.gr
authors.forename: Ioannis
authors.initials: I
authors.lastname: Germanakis
authors.forename: Sven
authors.initials: S
authors.lastname: Dittrich
authors.forename: Rousa
authors.initials: R
authors.lastname: Perakaki
authors.forename: Maria
authors.initials: M
authors.lastname: Kalmanti
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006337:Heart Murmurs / Q000175:diagnosis; D006801:Humans; D007223:Infant; D008297:Male; D010701:Phonocardiography / Q000379:methods*; D012680:Sensitivity and Specificity; D014463:Ultrasonography