The humble stethoscope could avoid unnecessary use of more expensive investigations like echocardiography for diagnosis of cardiac defects and allow for substantial reductions in healthcare costs, as per a research study done at the Amrita Hospital here.
Published in the British Medical Journal – Paediatrics Open, the study was conducted in 545 children with suspected congenital heart defects, and systematically tested the diagnostic accuracy of physical examination of the cardiovascular system, comparing it with echocardiography, the current gold standard to diagnose heart conditions.
The study was able to differentiate normal hearts from abnormal ones with an accuracy of 95 per cent and above.
R. Krishna Kumar, Clinical Professor and Head, Paediatric Cardiology, Amrita Hospital, who led the study, said with increasing availability of ultrasound technology in cardiology in the form of echocardiography, there is a perception that physical examination of the patient with the age-old stethoscope is becoming redundant.
“In the West, skills in using stethoscope have declined to the point where many doctors have stopped using it altogether. However, in India, many doctors still use the stethoscope to good effect and arrive at an accurate diagnosis. They recommend echocardiography only when a significant heart condition is identified.
“The purpose of this study was to validate the accuracy of examining the patient and listening with the stethoscope using a structured protocol and comparing the results with echocardiography,” he said.
Krishna Kumar pointed out that history and physical examination are traditional tools that contribute substantially to arriving at an accurate diagnosis and strengthens the doctor’s rapport with the patient.
“However, the importance of physical examination in patients with heart disease appears to be diminishing in recent times with the arrival of echocardiography. Our study found that the humble stethoscope can serve as a useful method to screen patients in outpatient clinics. Physical examination involving stethoscope is also quite good in correctly identifying common congenital heart diseases in children,” he said.
Citing the results, Krishna Kumar said: “This shows that when applied correctly, stethoscope could avoid unnecessary use of the more expensive investigations like echocardiography and allow for substantial reductions in healthcare costs and reduce the burden on the healthcare system. This finding is of great significance for healthcare in low-resource settings like India.”