Electronic stethoscope useful for preoperative screening of heart in kids with CHD

Congenital heart diseases (CHDs) are the most prevalent kind of birth abnormality, according to the Centers for Disease Control (CDC). Between 8 to 12 CHDs are born per 1000 live births. Children's preoperative cardiac assessment typically starts with a physical examination and history-taking, followed by any required tests. Even with experienced ears, it may be challenging to detect any murmur using the acoustic stethoscope when there are many patients waiting to be examined, there is a lack of time and resources, or if the screening space is excessively loud. An audio-visual auscultation tool called an electronic stethoscope combines a phonocardiogram with a traditional stethoscope. Recently, a research was conducted, notably in low- and middle-income nations, to determine the value of an electronic stethoscope as a link between the screening and diagnosis of pediatric murmurs and CHDs.

This research was done via observation. Using both stethoscopes, 50 kids between the ages of 0 and 12 with congenital heart disorders (CHDs) and 50 kids without CHD who were scheduled for echocardiography were evaluated. The results were compared to the echocardiography report and validated by clinical observations. Neither of the stethoscopes picked up any murmur among the 50 instances free of CHD. This was consistent with the TTE results. Both stethoscopes' calculated specificities were 100%. The electronic stethoscope detected murmurs in 32 of the 50 CHD patients while missing them in 18 of them. In 29 instances, the acoustic stethoscope detected murmurs; in 21 cases, it did not. Therefore, it was determined that the sensitivity of electronic and acoustic stethoscopes compared to TTE was 64% and 58%, respectively. The electronic stethoscope has a 100% positive predictive value vs a 73% negative predictive value when compared to TTE. The kappa score of 0.93 indicated 93% agreement. The Mc-Nemar test result of 0.24 indicates that there is no benefit of using an electronic stethoscope over an acoustic stethoscope for the identification of CHD in children.

Particularly in distant areas, the electronic stethoscope may be a useful tool for CHD screening. Additionally, it might be used to the burgeoning and emerging area of telemedicine. An electronic or acoustic stethoscope may be unable to identify CHD if there are no murmurs or just low-grade murmurs (although TTE can still detect them). Undiscovered flaws are often minor and may not be important enough to affect a child's cardiovascular system. When used as a cardiac screening tool during the preoperative examination of children, an electronic stethoscope (FONODOC) and an acoustic stethoscope both have a comparable rate of detecting congenital heart disease (CHD). The electronic stethoscope is equivalent to an acoustic stethoscope in terms of sensitivity and specificity, scoring 64% and 100%, respectively. As a result, echocardiography continues to be the gold standard for CHD diagnosis.

Reference –

Ahuja, Vasudha; Kini, Priyanka; Nileshwar, Anitha. Evaluation of the electronic stethoscope (FONODOC) as a cardiac screening tool during the preoperative evaluation of children. Indian Journal of Anaesthesia: September 2022 - Volume 66 - Issue 9 - p 625-630

doi: 10.4103/ija.ija_305_22