Initial Field Test of a Cloud-Based Cardiac Auscultation System to Determine Murmur Etiology in Rural China
Autor: | Xiaoju Yu, J Pan, Bistra Zheleva, Weiguang Shao, Pouya Hemmati, Jing Wang, Ke Liu, Andreas Tsakistos, Lee A. Pyles, Quan Ni |
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Rok vydání: | 2016 |
Předmět: |
Heart Defects
Congenital Male Rural Population medicine.medical_specialty Pediatrics China Heart disease Stethoscope Adolescent education 030204 cardiovascular system & hematology Sensitivity and Specificity Atrial septal defects law.invention 03 medical and health sciences 0302 clinical medicine law 030225 pediatrics medicine Humans Mass Screening cardiovascular diseases Child medicine.diagnostic_test Heart Murmurs business.industry Remote Consultation Phonocardiography Auscultation Cloud Computing medicine.disease Cardiac surgery Heart sounds Pediatrics Perinatology and Child Health Heart murmur Feasibility Studies Female medicine.symptom Cardiology and Cardiovascular Medicine Venous hum business Heart Auscultation |
Zdroj: | Pediatric cardiology. 38(4) |
ISSN: | 1432-1971 |
Popis: | A system for collection, distribution, and long distant, asynchronous interpretation of cardiac auscultation has been developed and field-tested in rural China. We initiated a proof-of-concept test as a critical component of design of a system to allow rural physicians with little experience in evaluation of congenital heart disease (CHD) to obtain assistance in diagnosis and management of children with significant heart disease. The project tested the hypothesis that acceptable screening of heart murmurs could be accomplished using a digital stethoscope and internet cloud transmittal to deliver phonocardiograms to an experienced observer. Of the 7993 children who underwent school-based screening in the Menghai District of Yunnan Province, Peoples Republic of China, 149 had a murmur noted by a screener. They had digital heart sounds and phonocardiograms collected with the HeartLink tele auscultation system, and underwent echocardiography by a cardiology resident from the First Affiliated Hospital of Kunming Medical University. The digital phonocardiograms, stored on a cloud server, were later remotely reviewed by a board-certified American pediatric cardiologist. Fourteen of these subjects were found to have CHD confirmed by echocardiogram. Using the HeartLink system, the pediatric cardiologist identified 11 of the 14 subjects with pathological murmurs, and missed three subjects with atrial septal defects, which were incorrectly identified as venous hum or Still's murmur. In addition, ten subjects were recorded as having pathological murmurs, when no CHD was confirmed by echocardiography during the field study. The overall test accuracy was 91% with 78.5% sensitivity and 92.6% specificity. This proof-of-concept study demonstrated the feasibility of differentiating pathologic murmurs due to CHD from normal functional heart murmurs with the HeartLink system. This field study is an initial step to develop a cost-effective CHD screening strategy in low-resource settings with a shortage of trained medical professionals and pediatric heart programs. |
Databáze: | OpenAIRE |
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