title: Computer-aided auscultation of murmurs in children: evaluation of commercially available software.
abstract: BACKGROUND
  Heart murmurs are common in children and may represent congenital or acquired cardiac pathology. Auscultation is challenging and many primary-care physicians lack the skill to differentiate innocent from pathologic murmurs. We sought to determine whether computer-aided auscultation (CardioscanTM) identifies which children require referral to a cardiologist.
  
  
  METHODS
  We consecutively enrolled children aged between 0 and 17 years with a murmur, innocent or pathologic, being evaluated in a tertiary-care cardiology clinic. Children being evaluated for the first time and patients with known cardiac pathology were eligible. We excluded children who had undergone cardiac surgery previously or were unable to sit still for auscultation. CardioscanTM auscultation was performed in a quiet room with the subject in the supine position. The sensitivity and specificity of a potentially pathologic murmur designation by CardioscanTM - that is, requiring referral - was determined using echocardiography as the reference standard.
  
  
  RESULTS
  We enrolled 126 subjects (44% female) with a median age of 1.7 years, with 93 (74%) having cardiac pathology. The sensitivity and specificity of a potentially pathologic murmur determination by CardioscanTM for identification of cardiac pathology were 83.9 and 30.3%, respectively, versus 75.0 and 71.4%, respectively, when limited to subjects with a heart rate of 50-120 beats per minute. The combination of a CardioscanTM potentially pathologic murmur designation or an abnormal electrocardiogram improved sensitivity to 93.5%, with no haemodynamically significant lesions missed.
  
  
  CONCLUSIONS
  Sensitivity of CardioscanTM when interpreted in conjunction with an abnormal electrocardiogram was high, although specificity was poor. Re-evaluation of computer-aided auscultation will remain necessary as advances in this technology become available.
authors.affiliation: 1Stollery Children's Hospital,Edmonton,Alberta,Canada.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Lee
authors.affiliation: 2Department of Pediatrics,University of Alberta,Alberta,Canada.
authors.forename: Kathryn N
authors.initials: KN
authors.lastname: Rankin
authors.affiliation: 1Stollery Children's Hospital,Edmonton,Alberta,Canada.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Zuo
authors.affiliation: 1Stollery Children's Hospital,Edmonton,Alberta,Canada.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Mackie
mesh_terms: D000293:Adolescent; D002170:Canada; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006326:Heart Auscultation / Q000379:methods*; D006337:Heart Murmurs / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000379:methods*; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D012984:Software / Q000592:standards*; D062606:Tertiary Care Centers
keywords: Heart murmur; auscultation; children; computer analysis; sensitivity; specificity