The Role of Transthoracic Echocardiography in the Diagnosis of Infective Endocarditis in Children

Aly, Ashraf M.; Simpson, Pippa; Humes, Richard A.

doi:10.1001/archpedi.153.9.950

Cited by 30 publications

(12 citation statements)

References 22 publications

(21 reference statements)

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“…26 Risk factors for transthoracic echocardiographic evidence of endocarditis that were identified in each of 2 pediatric reports included positive blood cultures, physical findings of new or changing heart murmur, and congestive heart failure. 27,28 Indications in neonates may be different. 26,27 Our experience shows that the feature of a new murmur should be defined as a new regurgitant murmur, 29 because a hyperdynamic condition associated with febrile illness can produce innocent murmurs.…”

Section: Discussionmentioning

confidence: 99%

Conditions Leading to Pediatric Cardiology Consultation in a Tertiary Academic Hospital

Geggel

2004

Pediatrics

126

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ABSTRACT. Objective. To determine the basis for cardiac consultations for pediatric patients in an academic hospital setting.Methods. The activities of the cardiology consultation service were tabulated for 12 months, from July 2001 to June 2002. Patients were identified from 4 sources, ie, a monthly log of patient encounters maintained by the consultation service, encounter forms submitted to the billing office, consultation notes maintained in a central file, and a departmental list of echocardiography studies. Patients who required clearance for noncardiac surgical procedures were generally evaluated in the cardiology clinic and not by the consultation service. Patient data were obtained from consultation and echocardiography reports and from hospital computer-based records for discharge summaries for inpatient admissions, emergency department encounter summaries, and laboratory reports. For each patient, consultations were tabulated as separate encounters if they occurred on different days in the emergency department, during separate admissions, or for different clinical concerns during a single admission.Results. A total of 2071 consultations were performed for 1724 patients. The age at the time of consultation was 6.6 ؎ 9.3 years (median: 1.2 years; range: 1 day to 60.6 years). A total of 1507 patients (87.4%) had a single consultation; 217 patients (12.6%) had multiple encounters, ranging from 2 to 9, accounting for 564 consultations (27.2%). Clinical concerns included murmurs (18.5%), cardiac function (12.7%), arrhythmias (12.7%), intercurrent illnesses among cardiac patients (11.3%), cyanosis (6.3%), syndromes (5.7%), chest pain (5.2%), syncope/dizziness (4.5%), subacute endocarditis (4.4%), follow-up evaluations of fetal diagnoses (4.3%), Kawasaki disease (3.4%), cor pulmonale (3%), recent cardiac surgery or catheterization (1.6%), cerebrovascular accidents (1.2%), and miscellaneous conditions. Four diagnoses accounted for 91% of murmur evaluations, ie, patent ductus arteriosus, ventricular septal defects, innocent murmurs, and pulmonary branch murmur of infancy. The most common murmur diagnosis in the neonatal intensive care unit was patent ductus arteriosus (68%), in the well-child nursery was ventricular septal defect (64%), and on the medical ward was innocent murmur (62%). The most common basis for evaluation of function was oncologic disease. Among patients evaluated for function, there were 3 new diagnoses of structural congenital heart disease, all involving neonates with aortic arch obstruction. Approximately two-thirds of arrhythmias were supraventricular in origin. The most common arrhythmias requiring treatment were supraventricular tachycardia and atrial flutter/fibrillation, the latter occurring mainly among older patients with structural heart disease. Diagnoses made with fetal echocardiography accounted for 14.3% of newborn consultations and included 83% of patients with cyanotic cardiac disease. Three syndromes accounted for 57% of consultations for this indication, ie, VACTERL associa...

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Section: Discussionmentioning

confidence: 99%

Conditions Leading to Pediatric Cardiology Consultation in a Tertiary Academic Hospital

Geggel

2004

Pediatrics

126

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“…Similarly, Aly and colleagues, studying a cohort of 173 children with varying levels of suspicion of endocarditis, also found that TTE was of limited value in those with a relatively low likelihood of infective endocarditis. 3 They proposed an algorithm for the use of TTE in infective endocarditis, and calculated that the number of examinations that their department would have to perform would be reduced by 80%. Both of the above studies help in decision making, but the processes described relied on different and often complicated criteria or flow charts in deciding whether or not TTE was appropriate.…”

Section: Discussionmentioning

confidence: 99%

Clinical criteria and the appropriate use of transthoracic echocardiography for the exclusion of infective endocarditis

Greaves

Mou²,

Patel³

et al. 2003

Heart

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Background: Clinical guidelines currently suggest that transthoracic echocardiography (TTE) be carried out in all patients with suspected endocarditis, but the use of TTE where there is a low probability of infective endocarditis has a poor diagnostic yield. This screening approach may no longer be appropriate. Objective: To examine whether clinical criteria might aid decision making with respect to the use of TTE in possible endocarditis. Design: A retrospective review of patient records. Setting: Cardiology department of a tertiary referral centre. Patients: 500 consecutive hospital inpatients referred for TTE to exclude endocarditis. Main outcome measures: Evidence of endocardial vegetations on TTE and the presence of predetermined clinical criteria that may predispose to, or be suggestive of, endocarditis. Results: Evidence of infective endocarditis was detected on echocardiography in 43 of the 500 patients (8.6%). In 239 patients (48%), vegetations and certain prespecified clinical criteria were both absent. These criteria were: vasculitic/embolic phenomena; the presence of central venous access; a recent history of injected drug use; presence of a prosthetic valve; and positive blood cultures. The collective absence of these five criteria indicated a zero probability of TTE showing evidence of endocarditis. Conclusions: The use of simple clinical criteria during the decision making process may avoid many unnecessary TTE examinations in hospital inpatients with a low probability of endocarditis.

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“…O papel do ecocardiograma transtorácico como meio diagnóstico em crianças com suspeita clínica de endocardite infecciosa ainda gera discussões, sendo assunto controverso entre vários autores 5,8,9,11 . Alguns autores o têm considerado de baixa sensibilidade como método para diagnóstico de EI em pacientes com poucos critérios clínicos da doença 9,12 , porém outros avaliam que o uso da ecocardiografia na avaliação de criança com suspeita clínica de endocardite tem ampla aplicação, principalmente por que, em pediatria, o eco transtorácico oferece excelente campo 4,11 .…”

Section: Discussionunclassified

“…Alguns autores o têm considerado de baixa sensibilidade como método para diagnóstico de EI em pacientes com poucos critérios clínicos da doença 9,12 , porém outros avaliam que o uso da ecocardiografia na avaliação de criança com suspeita clínica de endocardite tem ampla aplicação, principalmente por que, em pediatria, o eco transtorácico oferece excelente campo 4,11 . Neste estudo, alteração característica ao exame foi um dos critérios de inclusão.…”

Section: Discussionunclassified

Achados clínico-laboratoriais de uma série de casos com endocardite infecciosa

Pereira¹,

Rocio²,

Ceolin³

et al. 2003

J. Pediatr. (Rio J.)

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The Role of Transthoracic Echocardiography in the Diagnosis of Infective Endocarditis in Children

Cited by 30 publications

References 22 publications

Conditions Leading to Pediatric Cardiology Consultation in a Tertiary Academic Hospital

Conditions Leading to Pediatric Cardiology Consultation in a Tertiary Academic Hospital

Clinical criteria and the appropriate use of transthoracic echocardiography for the exclusion of infective endocarditis

Achados clínico-laboratoriais de uma série de casos com endocardite infecciosa

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