The Detection of Heart Disease in Children

Abstract

The validity of the tape recording method, as assessed by the several comparisons possible from the design of this study, was 66.7-77.8%. Pediatric cardiologists examined directly 25/1000 of the 8181 children surveyed. The validity rate for a direct examination team with cardiology training was 83%; it missed 17% of the heart disease cases (false negatives) and over-diagnosed 26% (false positives). The tape recording method has a built-in procedure for minimizing false positives, and for "delabelling" children incorrectly stigmatized as having heart disease. The prevalence rate for organic heart disease in this small mid-western city was 3.4/1000; this rate was of the same order of magnitude reported for Chicago public elementary school children. Congential heart disease was found to be 2-3 times more prevalent than rheumatic heart disease, reflecting the sharp decline in incidence rates for rheumatic fever and rheumatic heart disease in the USA since 1920. In 47.8% of the children with heart disease, the abnormality was previously unknown to the patient, his family, his physician, and his school just as was found in the Chicago study of children in the 6-14 year age group. The yield from either direct auscultation or the tape recording method was not significantly increased with addition of the electrocardiogram and/or the chest X-ray; both these procedures appear to be inadequate for high-validity detection of heart disease in children.