Sorting through the haystack—decision analysis and the search for heart disease among children with murmur

      Buried in the haystack of healthy children are needles of occult heart disease awaiting discovery. The hay can get mighty deep in a busy pediatrics office, and yet primary care pediatricians are expected to find all of the needles. Hip-deep in “well babies” and prospective kindergartners, and knowing that congenital heart disease (CHD) could toddle in the door without warning at any moment, clearly we need a detection strategy.

      Abbreviations:

      CHD ( Congenital heart disease)

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      Linked Article

      • Evaluation of heart murmurs in children: Cost-effectiveness and practical implications
        The Journal of PediatricsVol. 141Issue 4
        • In Brief
          Objective: To assess the cost-effectiveness of various strategies to evaluate heart murmurs in children. Methods: We modeled 6 strategies to follow the initial examination by the pediatrician: (1) refer suspected pathologic murmurs to a cardiologist, (2) obtain a chest radiograph (CXR) and electrocardiogram (ECG) and refer suspected pathologic murmurs to a cardiologist, (3) refer suspected pathologic murmurs for an echocardiogram (ECHO), (4) obtain a CXR and ECG and refer suspected pathologic murmurs for an ECHO, (5) refer all patients with murmurs to a cardiologist, or (6) refer all patients with murmurs for an ECHO.
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