Listening to heart sounds with the traditional stethoscope can distinguish with a high degree of accuracy hearts that are normal from those with defects, a study conducted by Amrita Hospital, Kochi, has found.
The research, conducted at Amrita Hospital, Kochi, found that a stethoscope could avoid unnecessary use of more expensive investigations like echocardiography and allow for substantial reductions in healthcare costs
The original research, published in British Medical Journal, Pediatrics Open, involved 545 children with suspected congenital heart defects. The study for the first time systematically tested the diagnostic accuracy of physical examination of the cardiovascular system in children and compared it with echocardiography, the current gold standard to diagnose heart conditions.
According to Dr R. Krishna Kumar, Clinical Professor and Head, Pediatric Cardiology, Amrita Hospital, Kochi, who led the study: “With the increasing availability of ultrasound technology in cardiology in the form of echocardiography, there is a perception that physical examination of the patient with the age-old stethoscope is becoming redundant. In the West, skills in using stethoscopes have declined to the point where many doctors have stopped using them altogether. However, in India, many doctors still use the stethoscope to good effect and arrive at an accurate diagnosis. They recommend echocardiography only when a significant heart condition is identified. The purpose of this study was to validate the accuracy of examining the patient and listening with the stethoscope using a structured protocol and comparing the results with echocardiography.”
He added: “History and physical examination are traditional tools that contribute substantially to arriving at an accurate diagnosis and strengthen the doctor’s rapport with the patient. However, the importance of physical examination in patients with heart disease appears to be diminishing in recent times with the arrival of echocardiography. Our study found that the humble stethoscope can serve as a useful method to screen patients in outpatient clinics. Physical examination involving a stethoscope is also quite good in correctly identifying common congenital heart diseases in children. Our study could differentiate normal hearts from abnormal ones with an accuracy of 95% and above. This shows that when applied correctly, a stethoscope could avoid unnecessary use of more expensive investigations like echocardiography and allow for substantial reductions in healthcare costs and reduce the burden on the healthcare system. This finding is of great significance for healthcare in low-resource settings like India.”
“The study underscores the utility of clinical examination in initial screening for commonly encountered congenital cardiac conditions in children even in the current era of echocardiography. It has been demonstrated that a stethoscope is fairly reliable in outpatient settings where the patients are relatively stable. However, the results of the study are truly valid for these settings only. They may not apply to in-patient settings, newborns with suspected heart disease, and situations where the doctors have not trained adequately in examining the heart and in using the stethoscope,” he said.