Abstract
The usefulness and cost-effectiveness of non-invasive procedures performed on 77 infants and children at their initial cardiac evaluation were determined. Over a 6 month period, patients (pts) seen for the first time in the pediatric cardiology clinics at Downstate Medical Center and Brookdale Hospital Medical Center, were examined separately by 3 board certified pediatric cardiologists. In addition, a chest X-ray,electrocardiogram (ECG), and echocardiogram were obtained on each patient and the results were compared with published standard norms for age. Dr. A performed a history (H) and physical (P) only. Dr. B performed an H and P and reviewed the ECG and chest X-ray only. Dr. C performed an H and P and reviewed the echocardiogram only. Each doctor then independently classified a patient as having (I) definite heart disease, (II) possible heart disease, or (III) no heart disease. The 3 doctors agreed in 68 pts (88%). In 9 pts there was an interobserver disagreement. 2 pts were classified as I and II and 7 pts were classified as II and III. No pts were classified as I and III or I, II, and III. We conclude that routine non-invasive studies are not necessary at initial cardiac evaluation in order to differentiate heart disease from no heart disease. Therefore, selective use of these studies should result in significant reduction of health care costs.(Supported by HHS Grant #1RO1 HSO4935-01).
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