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The Utility of Echocardiography in Pediatric Patients with Structurally Normal Hearts and Suspected Endocarditis
The objective of this study was to evaluate the utility of transthoracic echocardiography (TTE) in children with structurally normal hearts suspected of having infective endocarditis (IE). We hypothesized that the diagnostic yield of TTE is minimal in low-risk patients with normal hearts. We perform...
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| Published in: | Pediatric cardiology 2020, Vol.41 (1), p.62-68 |
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| Main Authors: | , , , , , |
| Format: | Article |
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| cited_by | cdi_FETCH-LOGICAL-c414t-ef25df0a0fcdbe51257e47f081998bdef95a10d06b34331cd6f647ca250eb003 |
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| cites | cdi_FETCH-LOGICAL-c414t-ef25df0a0fcdbe51257e47f081998bdef95a10d06b34331cd6f647ca250eb003 |
| container_end_page | 68 |
| container_issue | 1 |
| container_start_page | 62 |
| container_title | Pediatric cardiology |
| container_volume | 41 |
| creator | Kelly, Patrick Hua, Nancy Madriago, Erin J. Holmes, Kathryn W. Shaughnessy, Robin Ronai, Christina |
| description | The objective of this study was to evaluate the utility of transthoracic echocardiography (TTE) in children with structurally normal hearts suspected of having infective endocarditis (IE). We hypothesized that the diagnostic yield of TTE is minimal in low-risk patients with normal hearts. We performed a retrospective chart review of TTEs performed for concern for endocarditis at a pediatric tertiary care referral center in Portland, Oregon. Three hundred patients met inclusion criteria ( |
| doi_str_mv | 10.1007/s00246-019-02222-z |
| format | article |
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We hypothesized that the diagnostic yield of TTE is minimal in low-risk patients with normal hearts. We performed a retrospective chart review of TTEs performed for concern for endocarditis at a pediatric tertiary care referral center in Portland, Oregon. Three hundred patients met inclusion criteria (< 21 years old, completed TTE for IE from 2005 to 2015, no history of congenital heart disease or endocarditis). We recorded findings that met the modified Duke criteria (MDC) including fever, positive blood culture, and vascular/immunologic findings; presence of a central line; whether or not patients were diagnosed with IE clinically; and if any changes to antibiotic regimens were made based on TTE. Ten patients (3%) had echocardiograms consistent with IE. When compared to the clinical diagnosis of IE, the positive predictive value (PPV) of one positive blood culture without other major/minor MDC was 0. Similarly, the PPV of two positive blood cultures without other major/minor criteria was 0.071. Patients should be evaluated using the MDC to assess the clinical probability of IE prior to performing a TTE. Patients with a low probability for IE should not undergo TTE as it has a low diagnostic yield and patients are unlikely to be diagnosed with disease.</description><identifier>ISSN: 0172-0643</identifier><identifier>EISSN: 1432-1971</identifier><identifier>DOI: 10.1007/s00246-019-02222-z</identifier><identifier>PMID: 31673735</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adolescent ; Adult ; Blood ; Cardiac patients ; Cardiac Surgery ; Cardiology ; Child ; Children ; Congenital heart disease ; Echocardiography ; Echocardiography, Transesophageal ; Endocarditis, Bacterial - blood ; Endocarditis, Bacterial - diagnostic imaging ; Endocarditis, Bacterial - physiopathology ; Female ; Genetic disorders ; Health aspects ; Humans ; Infective endocarditis ; Male ; Medical examination ; Medicine ; Medicine & Public Health ; Original Article ; Pediatrics ; Predictive Value of Tests ; Retrospective Studies ; Vascular Surgery ; Young Adult</subject><ispartof>Pediatric cardiology, 2020, Vol.41 (1), p.62-68</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2019</rights><rights>COPYRIGHT 2020 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-ef25df0a0fcdbe51257e47f081998bdef95a10d06b34331cd6f647ca250eb003</citedby><cites>FETCH-LOGICAL-c414t-ef25df0a0fcdbe51257e47f081998bdef95a10d06b34331cd6f647ca250eb003</cites><orcidid>0000-0002-1503-7100</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31673735$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kelly, Patrick</creatorcontrib><creatorcontrib>Hua, Nancy</creatorcontrib><creatorcontrib>Madriago, Erin J.</creatorcontrib><creatorcontrib>Holmes, Kathryn W.</creatorcontrib><creatorcontrib>Shaughnessy, Robin</creatorcontrib><creatorcontrib>Ronai, Christina</creatorcontrib><title>The Utility of Echocardiography in Pediatric Patients with Structurally Normal Hearts and Suspected Endocarditis</title><title>Pediatric cardiology</title><addtitle>Pediatr Cardiol</addtitle><addtitle>Pediatr Cardiol</addtitle><description>The objective of this study was to evaluate the utility of transthoracic echocardiography (TTE) in children with structurally normal hearts suspected of having infective endocarditis (IE). We hypothesized that the diagnostic yield of TTE is minimal in low-risk patients with normal hearts. We performed a retrospective chart review of TTEs performed for concern for endocarditis at a pediatric tertiary care referral center in Portland, Oregon. Three hundred patients met inclusion criteria (< 21 years old, completed TTE for IE from 2005 to 2015, no history of congenital heart disease or endocarditis). We recorded findings that met the modified Duke criteria (MDC) including fever, positive blood culture, and vascular/immunologic findings; presence of a central line; whether or not patients were diagnosed with IE clinically; and if any changes to antibiotic regimens were made based on TTE. Ten patients (3%) had echocardiograms consistent with IE. When compared to the clinical diagnosis of IE, the positive predictive value (PPV) of one positive blood culture without other major/minor MDC was 0. Similarly, the PPV of two positive blood cultures without other major/minor criteria was 0.071. Patients should be evaluated using the MDC to assess the clinical probability of IE prior to performing a TTE. Patients with a low probability for IE should not undergo TTE as it has a low diagnostic yield and patients are unlikely to be diagnosed with disease.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Blood</subject><subject>Cardiac patients</subject><subject>Cardiac Surgery</subject><subject>Cardiology</subject><subject>Child</subject><subject>Children</subject><subject>Congenital heart disease</subject><subject>Echocardiography</subject><subject>Echocardiography, Transesophageal</subject><subject>Endocarditis, Bacterial - blood</subject><subject>Endocarditis, Bacterial - diagnostic imaging</subject><subject>Endocarditis, Bacterial - physiopathology</subject><subject>Female</subject><subject>Genetic disorders</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Infective endocarditis</subject><subject>Male</subject><subject>Medical examination</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Pediatrics</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Vascular Surgery</subject><subject>Young Adult</subject><issn>0172-0643</issn><issn>1432-1971</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kUGL1DAYhoso7rj6BzxIwIuXrl-StmmPyzK6wqILO55DmnyZydI2NUlZZn-9GbsKgpgcAvme9yXkKYq3FC4ogPgYAVjVlEC7Elhe5eOzYkMrzkraCfq82AAVrISm4mfFqxjvAaCFtn5ZnHHaCC54vSnm3QHJ9-QGl47EW7LVB69VMM7vg5oPR-ImcovGqRScJrcqOZxSJA8uHchdCotOS1DDcCRffRjVQK5RhTxXkyF3S5xRJzRkO5m1NLn4unhh1RDxzdN5Xuw-bXdX1-XNt89fri5vSl3RKpVoWW0sKLDa9FhTVgushIWWdl3bG7RdrSgYaHpecU61aWxTCa1YDdgD8PPiw1o7B_9jwZjk6KLGYVAT-iVKxiltKtpyntH3K7pXA0o3WZ-C0idcXgpa11R07FR48Q8qb4Oj035C6_L9XwG2BnTwMQa0cg5uVOEoKciTP7n6k9mf_OVPPubQu6dnL_2I5k_kt7AM8BWIeTTtMch7v4Qp_-T_an8CEqimqQ</recordid><startdate>2020</startdate><enddate>2020</enddate><creator>Kelly, Patrick</creator><creator>Hua, Nancy</creator><creator>Madriago, Erin J.</creator><creator>Holmes, Kathryn W.</creator><creator>Shaughnessy, Robin</creator><creator>Ronai, Christina</creator><general>Springer US</general><general>Springer</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1503-7100</orcidid></search><sort><creationdate>2020</creationdate><title>The Utility of Echocardiography in Pediatric Patients with Structurally Normal Hearts and Suspected Endocarditis</title><author>Kelly, Patrick ; Hua, Nancy ; Madriago, Erin J. ; Holmes, Kathryn W. ; Shaughnessy, Robin ; Ronai, Christina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-ef25df0a0fcdbe51257e47f081998bdef95a10d06b34331cd6f647ca250eb003</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Blood</topic><topic>Cardiac patients</topic><topic>Cardiac Surgery</topic><topic>Cardiology</topic><topic>Child</topic><topic>Children</topic><topic>Congenital heart disease</topic><topic>Echocardiography</topic><topic>Echocardiography, Transesophageal</topic><topic>Endocarditis, Bacterial - blood</topic><topic>Endocarditis, Bacterial - diagnostic imaging</topic><topic>Endocarditis, Bacterial - physiopathology</topic><topic>Female</topic><topic>Genetic disorders</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Infective endocarditis</topic><topic>Male</topic><topic>Medical examination</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Pediatrics</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Vascular Surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kelly, Patrick</creatorcontrib><creatorcontrib>Hua, Nancy</creatorcontrib><creatorcontrib>Madriago, Erin J.</creatorcontrib><creatorcontrib>Holmes, Kathryn W.</creatorcontrib><creatorcontrib>Shaughnessy, Robin</creatorcontrib><creatorcontrib>Ronai, Christina</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kelly, Patrick</au><au>Hua, Nancy</au><au>Madriago, Erin J.</au><au>Holmes, Kathryn W.</au><au>Shaughnessy, Robin</au><au>Ronai, Christina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Utility of Echocardiography in Pediatric Patients with Structurally Normal Hearts and Suspected Endocarditis</atitle><jtitle>Pediatric cardiology</jtitle><stitle>Pediatr Cardiol</stitle><addtitle>Pediatr Cardiol</addtitle><date>2020</date><risdate>2020</risdate><volume>41</volume><issue>1</issue><spage>62</spage><epage>68</epage><pages>62-68</pages><issn>0172-0643</issn><eissn>1432-1971</eissn><abstract>The objective of this study was to evaluate the utility of transthoracic echocardiography (TTE) in children with structurally normal hearts suspected of having infective endocarditis (IE). We hypothesized that the diagnostic yield of TTE is minimal in low-risk patients with normal hearts. We performed a retrospective chart review of TTEs performed for concern for endocarditis at a pediatric tertiary care referral center in Portland, Oregon. Three hundred patients met inclusion criteria (< 21 years old, completed TTE for IE from 2005 to 2015, no history of congenital heart disease or endocarditis). We recorded findings that met the modified Duke criteria (MDC) including fever, positive blood culture, and vascular/immunologic findings; presence of a central line; whether or not patients were diagnosed with IE clinically; and if any changes to antibiotic regimens were made based on TTE. Ten patients (3%) had echocardiograms consistent with IE. When compared to the clinical diagnosis of IE, the positive predictive value (PPV) of one positive blood culture without other major/minor MDC was 0. Similarly, the PPV of two positive blood cultures without other major/minor criteria was 0.071. Patients should be evaluated using the MDC to assess the clinical probability of IE prior to performing a TTE. Patients with a low probability for IE should not undergo TTE as it has a low diagnostic yield and patients are unlikely to be diagnosed with disease.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>31673735</pmid><doi>10.1007/s00246-019-02222-z</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-1503-7100</orcidid></addata></record> |
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| subjects | Adolescent Adult Blood Cardiac patients Cardiac Surgery Cardiology Child Children Congenital heart disease Echocardiography Echocardiography, Transesophageal Endocarditis, Bacterial - blood Endocarditis, Bacterial - diagnostic imaging Endocarditis, Bacterial - physiopathology Female Genetic disorders Health aspects Humans Infective endocarditis Male Medical examination Medicine Medicine & Public Health Original Article Pediatrics Predictive Value of Tests Retrospective Studies Vascular Surgery Young Adult |
| title | The Utility of Echocardiography in Pediatric Patients with Structurally Normal Hearts and Suspected Endocarditis |
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