The impact of computer-assisted auscultation on physician referrals of asymptomatic patients with heart murmurs

Background: As many as 50-70% of asymptomatic children referred for specialist evaluation or echocardiography because of a murmur have no heart disease. Hypothesis: Computer-assisted auscultation (CAA) can improve the sensitivity and specificity of referrals for evaluation of heart murmurs. Methods: Seven board-certified primary care physicians were evaluated both without and with use of a computer-based decision-support system using 100 pre-recorded patient heart sounds (55 innocent murmurs, 30 pathological murmurs, 15 without murmur). The sensitivity and specificity of their murmur referral decisions relative to American College of Cardiology/American Heart Association (ACC/AHA) guidelines, and sensitivity and specificity of murmur detection and characterization (innocent versus pathological) were measured. Results: Sensitivity for detection of murmurs significantly increased with use of CAA from 76.6 to 89.1% (p < 0.001), while specificity remained unaffected (80.0 versus 81.0%). Computer-assisted auscultation improved sensitivity of correctly identifying pathological murmur cases from 82.4 to 90.0%, and specificity of correctly identifying benign cases (with innocent or no murmurs) from 74.9 to 88.8%. (p < 0.001). Referral sensitivity increased from 86.7 to 92.9%, while specificity increased from 63.5 to 78.6% using CAA (p < 0.001). Conclusions: Computer-assisted auscultation appears to be a promising new technology for informing the referral decisions of primary care physicians.