A prospective study comparing the diagnostic accuracy of General Pediatricians (Gen Ped) to Pediatric Cardiologists (Ped Card) in the clinical evaluation of heart murmurs was undertaken. A total of 118 patients (51% male), 1 month to 17.65 years (median 3 years), newly referred to the pediatric cardiology clinic for heart murmurs were classified as innocent(INN), pathologic (P) or possibly pathologic (PP). The initial diagnosis was subject to revision after the review of electrocardiogram (EKG) and chest x-ray (CXR). Observations made by the investigators were recorded separately and remained blinded until the study was completed. The final diagnosis was ascertained by echocardiography (84 normal, 34 abnormal).Table Table

Table 1
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EKG and CXR prompted correction of diagnosis from INN to P in 2 patients (1 Gen Ped, 1 Ped Card). Sensitivity (23/34 vs 20/34) and NPV was similar for both groups. Ped Card had higher specificity (47/84 vs 63/84) and PPV. Diagnostic accuracy (70/91 vs 83/91) was in favor of Ped Card, but this did not attain statistical significance. We conclude that Gen Ped are comparable to Ped Card in the prediction of innocent murmurs (87%vs 93%) and in screening patients for pathologic murmurs (27/34vs 29/34), even though Gen Ped over estimated the diagnosis of pathologic murmurs (23/37 vs 20/23).

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