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March 2, 2009

Heart Disease Screening of Schoolchildren in Taiwan

Author Affiliations

Author Affiliations: Department of Pediatrics, Mackay Memorial Hospital, Taitung (Dr Yu); Department of Pediatrics, St Mary's Hospital, Lotung (Dr Lue); Department of Surgery (Dr Wu) and Division of Cardiology, Department of Pediatrics (Dr Chen), Mackay Memorial Hospital; and Mackay Medicine, Nursing, and Management College, Taipei (Dr Chen), Taiwan.

Arch Pediatr Adolesc Med. 2009;163(3):233-237. doi:10.1001/archpediatrics.2008.562

Objective  To evaluate the sensitivity of a heart disease screening program for schoolchildren.

Design  Prospective cohort study.

Setting  Taitung County, Taiwan.

Participants  All first- and fourth-grade elementary school students and first-year junior high school students screened between September 1, 2005, and June 30, 2007.

Intervention  A 2-level heart disease screening program was undertaken. Level 1 screening included a history questionnaire and phonocardiography and electrocardiography. Level 2 screening consisted of examination by a pediatric cardiologist of all children who had abnormal findings on level 1 screening. A control group comprised children whose level 1 screening results were normal. Children with abnormalities on level 2 screening were referred for a detailed cardiac evaluation.

Main Outcome Measures  Previously unsuspected heart diseases.

Results  Of 25 816 children undergoing the level 1 screening program, 5330 had positive findings, of whom 5235 underwent level 2 screening, along with 1104 children in the control group. The pediatric cardiologist referred 780 children to the hospital for full evaluation, including 18 controls and 114 patients with a previous diagnosis of heart disease. A total of 292 children, including 2 controls, had evidence of heart disease, which was previously unsuspected in 178 (61.0%). Excluding children with a previous diagnosis of heart disease, the sensitivity of the screening program was 82.6%. The specificity and the positive predictive value were 98.3% and 28.6%, respectively.

Conclusion  The 2-level heart disease screening program has good sensitivity and detects asymptomatic but potentially life-threatening heart disease in some children.