[May heart murmurs be assessed by telemedicine?].

BACKGROUND

Children often have heart murmurs; referral to a specialist is common. A service for remote auscultation of heart murmurs was established in which heart sounds and short texts were sent as attachment to e-mails. Our aim was to assess the quality of this method.

MATERIAL AND

METHODS

Heart sounds from 47 patients with no murmur (n = 7), innocent murmurs (n = 20), or with pathological murmurs (n = 20) were recorded using a sensor-based stethoscope and e-mailed to a computer. The sounds were repeated giving 100 cases, randomly distributed on a CD. Four specialists categorised the cases as having "no murmur", "innocent murmur", or "pathological murmur", recorded assessment time, degree of certainty, and need for referral.

RESULTS

On average 2.1 minutes were spent on each case. Mean sensitivity and specificity were 90% and 98%, respectively. Inter- and intra-observer variability were low (kappa 0.81 and 0.87). 93% of cases with a pathological murmur and 13% with an innocent murmur were recommended for referral.

INTERPRETATION: Telemedical referral of children with heart murmurs to a cardiologist is safe, reduces travelling, and saves time. Skilled auscultation is adequate to detect those with innocent murmurs.