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Utility of Store-and-Forward Pediatric Telecardiology Evaluation in Distinguishing Normal From Pathologic Pediatric Heart Sounds

Pediatric Department (Cardiology), Tripler Army Medical Center, Honolulu, Hawaii, Christopher.Mahnke{at}us.army.mil

Michael P. Mulreany, MD

Pediatric Department (Cardiology), Tripler Army Medical Center, Honolulu, Hawaii

Jill Inafuku, RDCS

Pediatric Department (Cardiology), Tripler Army Medical Center, Honolulu, Hawaii

Mazen Abbas, DO

Pediatric Department (Cardiology), Tripler Army Medical Center, Honolulu, Hawaii

Brian Feingold, MD

Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania

Joseph A. Paolillo, MD

University of Florida, Gainesville, Florida

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.

Key Words: cardiology • telemedicine

This version was published on November 1, 2008

Clinical Pediatrics, Vol. 47, No. 9, 919-925 (2008)
DOI: 10.1177/0009922808320596


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