title: The utility of outpatient echocardiography for evaluation of asymptomatic murmurs in children.
abstract: OBJECTIVE
  The purpose of this study is to review sedated outpatient echocardiograms performed to evaluate asymptomatic murmurs in children between the ages of 1 month and 4 years and describe outcomes of tests done to determine if utility varies among age of study and referral type (primary care physician vs. pediatric cardiologist.) We aim to describe the yield in a contemporary cohort which has increased availability and quality of diagnostic aids such as fetal ultrasound, newborn pulse oximetry, and neonatal echocardiography.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Cincinnati Children's Hospital Medical Center: Outpatient Echocardiography Laboratory.
  
  
  METHODS
  Children between 1 month and 4 years of age with asymptomatic murmurs who are referred for outpatient echocardiogram for evaluation of murmur.
  
  
  METHODS
  Primary diagnosis of echocardiography studies, classified into severity score. Results.  Four hundred sixty-two sedated echocardiograms were studied. Six (1%) echocardiograms showed severe pathology, and no severe pathology was shown in the echocardiograms ordered at the age of over 6 months old. The yield of studies decreased as age increased. The incidence of abnormal pathology was higher among tests ordered by cardiologists, across all severity levels (P < .0001).
  
  
  CONCLUSIONS
  Among echocardiograms ordered for children over 1 year of age with an asymptomatic murmur, there was no severe and little moderate disease. Cardiac disease is significantly less likely when echocardiograms are ordered without referral to a pediatric cardiologist. The workup for asymptomatic murmurs does not require an echocardiogram, and these results may aid clinicians when deciding whether evaluation of a child should include this study.
authors.affiliation: Heart Institute Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH45229, USA. david.kwiatkowski@cchmc.org
authors.forename: David
authors.initials: D
authors.lastname: Kwiatkowski
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: James
authors.initials: J
authors.lastname: Cnota
mesh_terms: D000367:Age Factors; D000553:Ambulatory Care; D058070:Asymptomatic Diseases; D002675:Child, Preschool; D003661:Decision Support Techniques; D015150:Echocardiography, Doppler; D005260:Female; D006337:Heart Murmurs / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009820:Ohio / Q000453:epidemiology; D018579:Patient Selection; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index