Screening schoolchildren for heart disease is an effective way to detect asymptomatic but potentially life-threatening conditions, Taiwanese researchers have shown.
Sudden death affects around 6.4 per 1,000,000 children each year and has a cardiac cause in around two-thirds of cases, although the vast majority of children are not known to have cardiovascular disease before death.
In this study, Chang-Hsien Yu (Mackay Mremorial Hospital, Taitung, Taiwan) and colleagues evaluated the sensitivity of a screening program to detect congenital or acquired heart disease in schoolchildren. The program followed the two-stage model used in Japan, where such screening is compulsory by law.
In all, 25,816 children underwent first-level screening that involved a questionnaire, electrocardiography, and phonocardiography. Of these, 5235 children had abnormal results and were evaluated by a pediatric cardiologist, along with 1104 controls whose initial results were normal.
Ultimately, 292 children were diagnosed with heart disease, including two from the control group. In 178 children heart disease had not been suspected prior to screening and in 26 cases the condition was potentially lethal, including prolonged QT interval, second-degree heart block, and serious congenital heart disease.
After excluding children with a known cardiac diagnosis, Yu et al calculated that the two-stage screening program had a sensitivity of 82.6%, a specificity of 98.3%, and a positive predictive value of 28.6%.
Writing in the Archives of Pediatric and Adolescent Medicine, they say that the program is useful in detecting asymptomatic heart disease and is likely to be cost-effective, especially in an area where medical resources are scarce or underused.
“We believe that these results highlight the need for periodic heart disease screening for schoolchildren in Taitung County,” they write.
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