title: Utility of store-and-forward pediatric telecardiology evaluation in distinguishing normal from pathologic pediatric heart sounds.
abstract: Because pediatric cardiologists can accurately diagnose innocent murmurs by physical exam alone, the authors developed a system for remote cardiac auscultation. They hypothesized that their system could accurately classify auscultatory findings as normal/innocent or pathologic. Patients undergoing evaluation underwent examination, echocardiography, and heart sound recording. Pediatric cardiologists evaluated the heart sounds and classified the case as either normal/innocent or pathologic. They reviewed103 heart sound data sets; 85% of the cases were accurately classified as either normal/innocent or pathologic, with a sensitivity of 82% and specificity of 86%. However, when accounting for clinical diagnosis, reviewer uncertainty, and ECG abnormalities, the sensitivity and specificity improved to 91% and 88% (accuracy 89%), respectively. Degree of certainty with the telecardiology diagnosis correlated with correct interpretation (P < .005). Digital heart sound recordings evaluated via telemedicine can distinguish normal/innocent murmurs from pathologic ones. Such a system could improve the use of pediatric cardiology services.
authors.affiliation: Pediatric Department (Cardiology), Tripler Army Medical Center, Honolulu, Hawaii 96859-5000, USA. Christopher.Mahnke@us.army.mil
authors.forename: C Becket
authors.initials: CB
authors.lastname: Mahnke
authors.forename: Michael P
authors.initials: MP
authors.lastname: Mulreany
authors.forename: Jill
authors.initials: J
authors.lastname: Inafuku
authors.forename: Mazen
authors.initials: M
authors.lastname: Abbas
authors.forename: Brian
authors.initials: B
authors.lastname: Feingold
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Paolillo
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006326:Heart Auscultation; D006331:Heart Diseases / Q000175:diagnosis*; D006337:Heart Murmurs / Q000175:diagnosis*; D006347:Heart Sounds; D006801:Humans; D007223:Infant; D008297:Male; D012680:Sensitivity and Specificity; D017216:Telemedicine; D014584:User-Computer Interface