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Neonatology 2016Heart rate assessment immediately after birth in newborn infants is critical to the correct guidance of resuscitation efforts. There are disagreements as to the best... (Review)
Review
BACKGROUND
Heart rate assessment immediately after birth in newborn infants is critical to the correct guidance of resuscitation efforts. There are disagreements as to the best method to measure heart rate.
OBJECTIVE
The aim of this study was to assess different methods of heart rate assessment in newborn infants at birth to determine the fastest and most accurate method.
METHODS
PubMed, EMBASE and Google Scholar were systematically searched using the following terms: 'infant', 'heart rate', 'monitoring', 'delivery room', 'resuscitation', 'stethoscope', 'auscultation', 'palpation', 'pulse oximetry', 'electrocardiogram', 'Doppler ultrasound', 'photoplethysmography' and 'wearable sensors'.
RESULTS
Eighteen studies were identified that described various methods of heart rate assessment in newborn infants immediately after birth. Studies examining auscultation, palpation, pulse oximetry, electrocardiography and Doppler ultrasound as ways to measure heart rate were included. Heart rate measurements by pulse oximetry are superior to auscultation and palpation, but there is contradictory evidence about its accuracy depending on whether the sensor is connected to the infant or the oximeter first. Several studies indicate that electrocardiogram provides a reliable heart rate faster than pulse oximetry. Doppler ultrasound shows potential for clinical use, however future evidence is needed to support this conclusion.
CONCLUSION
Heart rate assessment is important and there are many measurement methods. The accuracy of routinely applied methods varies, with palpation and auscultation being the least accurate and electrocardiogram being the most accurate. More research is needed on Doppler ultrasound before its clinical use.
Topics: Heart Function Tests; Heart Rate; Humans; Infant, Newborn; Neonatal Screening; Resuscitation
PubMed: 26684743
DOI: 10.1159/000441940 -
Pneumologie (Stuttgart, Germany) Jun 2016Auscultation of the lung is an inexpensive, noninvasive and easy-to-perform tool. It is an important part of the physical examination and is help ful to distinguish... (Review)
Review
Auscultation of the lung is an inexpensive, noninvasive and easy-to-perform tool. It is an important part of the physical examination and is help ful to distinguish physiological respiratory sounds from pathophysiological events. Computerized lung sound analysis is a powerful tool for optimizing and quantifying electronic auscultation based on the specific lung sound spectral characteristics. The automatic analysis of respiratory sounds assumes that physiological and pathological sounds are reliably analyzed based on special algorithms. The development of automated long-term lungsound monitors enables objective assessment of different respiratory symptoms.
Topics: Algorithms; Auscultation; Diagnosis, Computer-Assisted; Diagnosis, Differential; Humans; Lung Diseases; Respiratory Sounds; Sound Spectrography
PubMed: 27177168
DOI: 10.1055/s-0042-106155 -
Current Problems in Cardiology Feb 2023A heart murmur in adults is a common reason for referral for echocardiography at most general cardiology clinics in Europe. A murmur may indicate either a mild... (Review)
Review
A heart murmur in adults is a common reason for referral for echocardiography at most general cardiology clinics in Europe. A murmur may indicate either a mild age-related valvular calcification or regurgitation, or represent a significant heart valve disease requiring valvular intervention. Generally, the correlation between murmurs by auscultation and severity of heart valve disease by echocardiography is poor. Particularly, the severity and characterization of diastolic murmurs by auscultation may poorly correlate with echocardiographic findings. This narrative review aims to summarize the differential diagnoses of physiological and pathological murmurs, describes the current referral practice of murmur patients for echocardiography, and presents a single-center experience on the correlation of auscultation and echocardiographic findings with a particular focus on aortic and mitral valve diseases. A careful auscultation of the heart prior to the echocardiogram is mandatory and may help to predict the echocardiographic findings and their interpretation in view of the clinical information. The correlation between clinical examination, point of care ultrasound and standard echocardiography is a matter of continued exploration.
Topics: Adult; Humans; Heart Auscultation; Cardiologists; Heart Murmurs; Echocardiography; Heart Valve Diseases
PubMed: 36336114
DOI: 10.1016/j.cpcardiol.2022.101479 -
Journal of Multidisciplinary Healthcare 2019Cardiac auscultation - even with its limitations - is still a valid and economical technique for the diagnosis of cardiovascular diseases, and despite the growing demand... (Review)
Review
Cardiac auscultation - even with its limitations - is still a valid and economical technique for the diagnosis of cardiovascular diseases, and despite the growing demand for sophisticated imaging techniques, clinical use of the stethoscope in medical practice has not yet been abandoned. In 1816, René-Théophile-Hyacinthe Laënnec invented the stethoscope, while examining a young woman with suspected heart disease, giving rise to mediated auscultation. He described in detail several heart and lung sounds, correlating them with postmortem pathology. Even today, a correct interpretation of heart sounds, integrated with the clinical history and physical examination, allows to detect properly most of the structural heart abnormalities or to evaluate them in a differential diagnosis. However, the lack of organic teaching of auscultation and its inadequate practice have a negative impact on the clinical competence of physicians in training, also reflecting a diminished academic interest in physical semiotic. Medical simulation could be an effective instructional tool in teaching and deepening auscultation. Handheld ultrasound devices could be used for screening or for integrating and improving auscultatory abilities of physicians; the electronic stethoscope, with its new digital capabilities, will help to achieve a correct diagnosis. The availability of innovative representations of the sounds with phono- and spectrograms provides an important aid in diagnosis, in teaching practice and pedagogy. Technological innovations, despite their undoubted value, must complement and not supplant a complete physical examination; clinical auscultation remains an important and cost-effective screening method for the physicians in cardiorespiratory diagnosis. Cardiac auscultation has a future, and the stethoscope has not yet become a medical heirloom.
PubMed: 30881010
DOI: 10.2147/JMDH.S193904 -
Sensors (Basel, Switzerland) Jun 2023(1) Background: Mastery of auscultation can be challenging for many healthcare providers. Artificial intelligence (AI)-powered digital support is emerging as an aid to...
(1) Background: Mastery of auscultation can be challenging for many healthcare providers. Artificial intelligence (AI)-powered digital support is emerging as an aid to assist with the interpretation of auscultated sounds. A few AI-augmented digital stethoscopes exist but none are dedicated to pediatrics. Our goal was to develop a digital auscultation platform for pediatric medicine. (2) Methods: We developed StethAid-a digital platform for artificial intelligence-assisted auscultation and telehealth in pediatrics-that consists of a wireless digital stethoscope, mobile applications, customized patient-provider portals, and deep learning algorithms. To validate the StethAid platform, we characterized our stethoscope and used the platform in two clinical applications: (1) Still's murmur identification and (2) wheeze detection. The platform has been deployed in four children's medical centers to build the first and largest pediatric cardiopulmonary datasets, to our knowledge. We have trained and tested deep-learning models using these datasets. (3) Results: The frequency response of the StethAid stethoscope was comparable to those of the commercially available Eko Core, Thinklabs One, and Littman 3200 stethoscopes. The labels provided by our expert physician offline were in concordance with the labels of providers at the bedside using their acoustic stethoscopes for 79.3% of lungs cases and 98.3% of heart cases. Our deep learning algorithms achieved high sensitivity and specificity for both Still's murmur identification (sensitivity of 91.9% and specificity of 92.6%) and wheeze detection (sensitivity of 83.7% and specificity of 84.4%). (4) Conclusions: Our team has created a technically and clinically validated pediatric digital AI-enabled auscultation platform. Use of our platform could improve efficacy and efficiency of clinical care for pediatric patients, reduce parental anxiety, and result in cost savings.
Topics: Humans; Child; Artificial Intelligence; Auscultation; Stethoscopes; Heart Murmurs; Algorithms; Respiratory Sounds
PubMed: 37420914
DOI: 10.3390/s23125750 -
British Journal of Hospital Medicine... Feb 2019
Topics: Echocardiography; Electrocardiography; Heart Auscultation; Heart Murmurs; Heart Septal Defects; Heart Sounds; Heart Valve Diseases; Humans
PubMed: 30747003
DOI: 10.12968/hmed.2019.80.2.C28 -
Micromachines Nov 2023The aim of this work is to present a preliminary study for the design of a digital auscultation system, i.e., a novel wearable device for patient chest auscultation and...
The aim of this work is to present a preliminary study for the design of a digital auscultation system, i.e., a novel wearable device for patient chest auscultation and a digital stethoscope. The development and testing of the electronic stethoscope prototype is reported with an emphasis on the description and selection of sound transduction systems and analog electronic processing. The focus on various microphone technologies, such as micro-electro-mechanical systems (MEMSs), electret condensers, and piezoelectronic diaphragms, intends to emphasize the most suitable transducer for auscultation. In addition, we report on the design and development of a digital acquisition system for the human body for sound recording by using a modular device approach in order to fit the chosen analog and digital mics. Tests were performed on a designed phantom setup, and a qualitative comparison between the sounds recorded with the newly developed acquisition device and those recorded with two commercial digital stethoscopes is reported.
PubMed: 38004949
DOI: 10.3390/mi14112092 -
Scandinavian Journal of Primary Health... Dec 2022To investigate interrater and intrarater agreement between physicians and medical students on heart sound classification from audio recordings, and factors predicting...
OBJECTIVE
To investigate interrater and intrarater agreement between physicians and medical students on heart sound classification from audio recordings, and factors predicting agreement with a reference classification.
DESIGN
Intra- and interrater agreement study.
SUBJECTS
Seventeen GPs and eight cardiologists from Norway and the Netherlands, eight medical students from Norway.
MAIN OUTCOME MEASURES
Proportion of agreement and kappa coefficients for intrarater agreement and agreement with a reference classification.
RESULTS
The proportion of intrarater agreement on the presence of any murmur was 83% on average, with a median kappa of 0.64 (range = 0.09-0.86) for all raters, and 0.65, 0.69, and 0.61 for GPs, cardiologist, and medical students, respectively.The proportion of agreement with the reference on any murmur was 81% on average, with a median kappa of 0.67 (range 0.29-0.90) for all raters, and 0.65, 0.69, and 0.51 for GPs, cardiologists, and medical students, respectively.Distinct murmur, more than five years of clinical practice, and cardiology specialty were most strongly associated with the agreement, with ORs of 2.41 (95% CI 1.63-3.58), 2.19 (1.58-3.04), and 2.53 (1.46-4.41), respectively.
CONCLUSION
We observed fair but variable agreement with a reference on heart murmurs, and physician experience and specialty, as well as murmur intensity, were the factors most strongly associated with agreement.Key points:Heart auscultation is the main physical examination of the heart, but we lack knowledge of inter- and intrarater agreement on heart sounds.• Physicians identified heart murmurs from heart sound recordings fairly reliably compared with a reference classification, and with fair intrarater agreement.• Both intrarater agreement and agreement with the reference showed considerable variation between doctors• Murmur intensity, more than five years in clinical practice, and cardiology specialty were most strongly linked to agreement with the reference.
Topics: Humans; Heart Murmurs; Heart Auscultation; Heart Sounds; Students, Medical; Cardiology; Reproducibility of Results
PubMed: 36598178
DOI: 10.1080/02813432.2022.2159204 -
Pneumologie (Stuttgart, Germany) Jan 2019
Topics: Acoustics; Auscultation; Humans; Percussion
PubMed: 30536248
DOI: 10.1055/s-0043-125015