Abstract
Although screening of premature infants for PDA with L→R shunt is a dally nursery routine, little is known about the precision (observer agreement) and accuracy (agreement with gold standard) of the clinical exam. Both were studied prospectively on days 3-7 in 100 infants With BW<1750 g. Five independent observers (2 nurse specialists, 1 neonatal fellow, 1 neonatologist, 1 cardiologist) noted ↑ pulse volume, active precordium, heart murmur, cardio-thoracic ratio (CTR)> 60% and ↑ pulmonary vascular markings (PVM) on concurrent CXR. Colour flow doppler echocardiography was performed within 4 hours. All 100 tapes were reviewed by a 2nd cardiologist who was masked to the clinical signs. Twenty-four infants had a PDA on this gold standard test. A third of the entire cohort was intubated at the time of study. Precision of clinical signs was modest, with average kappas of 0.15 (or pulse volume, 0.36 for precordium and 0.47 for murmur. Mean sensitivities and specificities are shown in the table, together with the ranges between observers.
Clinical signs of a PDA are specific but insensitive. Abnormal signs strongly suggest a L→R shunt, while a normal exam does not exclude a PDA. (Supported by Resident Research Grant from the PSI Foundation)
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Davis, P., Turner-Gomes, S., Cunningham, K. et al. PRECISION AND ACCURACY OF CLINICAL SIGNS IN INFANTS AT RISK OF PATENT DUCTUS ARTERIOSUS (PDA). Pediatr Res 35, 272 (1994). https://doi.org/10.1203/00006450-199402000-00107
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DOI: https://doi.org/10.1203/00006450-199402000-00107