Detection of Heart Disease in Children 1919-1967

Since 1959, auscultation by physicians in screening 49,496 school children has yielded 4.5 cases of heart disease/1,000 students screened. Sensitivity by analysis of "inserted" cases averages 64%, but varies with capabilities of examining physicians. X-ray and ECG evaluations on smaller populations have yielded, respectively, 2.7 and 2.8 cases/1,000 children screened, and sensitivity results average 30 to 40%. The tape-recorded heart sounds technique has yielded 2.9 cases/1,000 in screening 188,925 children. Sensitivity by analysis of "inserted" cases averages 75% and, in the population of "naturally occurring" heart disease, 56%. In 23,148 school children, an analog-digital device (PhonoCardioScan) has yielded 4.8 cases/1,000 children screened. Of "inserted" cases, 69% have been detected. Sixtyfour to 80% of "naturally occurring" cases have been detected. With each technique, approximately 40% of the heart disease detected had been previously unknown. The specificity of these methods ranges from 95 to 99%. For primary screening the analog-digital device is the most effective currently available alternative to examination by cardiologists.