{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:25:38Z","timestamp":1790173538860,"version":"4.1.0"},"reference-count":15,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2008,2,6]],"date-time":"2008-02-06T00:00:00Z","timestamp":1202256000000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2008,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>As many as 50\u201370% of asymptomatic children referred for specialist evaluation or echocardiography because of a murmur have no heart disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis<\/jats:title><jats:p>Computer\u2010assisted auscultation (CAA) can improve the sensitivity and specificity of referrals for evaluation of heart murmurs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Seven board\u2010certified primary care physicians were evaluated both without and with use of a computer\u2010based decision\u2010support system using 100 prerecorded patient heart sounds (55 innocent murmurs, 30 pathological murmurs, 15 without murmur). The sensitivity and specificity of their murmur referral decisions relative to American College of Cardiology\/American Heart Association (ACC\/AHA) guidelines, and sensitivity and specificity of murmur detection and characterization (innocent versus pathological) were measured.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sensitivity for detection of murmurs significantly increased with use of CAA from 76.6 to 89.1% (p &lt;0.001), while specificity remained unaffected (80.0 versus 81.0%). Computer\u2010assisted auscultation improved sensitivity of correctly identifying pathological murmur cases from 82.4 to 90.0%, and specificity of correctly identifying benign cases (with innocent or no murmurs) from 74.9 to 88.8%. (p &lt;0.001). Referral sensitivity increased from 86.7 to 92.9%, while specificity increased from 63.5 to 78.6% using CAA (p &lt;0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Computer\u2010assisted auscultation appears to be a promising new technology for informing the referral decisions of primary care physicians. Copyright \u00a9 2008 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.20185","type":"journal-article","created":{"date-parts":[[2008,2,6]],"date-time":"2008-02-06T17:46:23Z","timestamp":1202319983000},"page":"79-83","source":"Crossref","is-referenced-by-count":48,"title":["The Impact of Computer\u2010assisted Auscultation on Physician Referrals of Asymptomatic Patients with Heart Murmurs"],"prefix":"10.1002","volume":"31","author":[{"given":"Raymond L.","family":"Watrous","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Reid","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey J.","family":"Ackerman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2008,2,7]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1067\/mcd.2001.115501"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1997.tb08580.x"},{"key":"e_1_2_1_4_2","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1001\/jama.1997.03540310062036","article-title":"Does this patient have an abnormal systolic murmur?","volume":"277","author":"Etchells E","year":"1997","journal-title":"JAMA"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/adc.81.5.409"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.1996.02170270051007"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(96)00200-7"},{"key":"e_1_2_1_8_2","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1542\/peds.91.2.365","article-title":"Cost assessment of the evaluation of heart murmurs in children","volume":"91","author":"Danford DA","year":"1993","journal-title":"Pediatrics"},{"key":"e_1_2_1_9_2","first-page":"54","article-title":"Nonspecific systolic murmurs: an audit of the clinical value of echocardiography","volume":"106","author":"Xu M","year":"1993","journal-title":"N Z Med J"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s002460010253"},{"key":"e_1_2_1_11_2","first-page":"368","article-title":"Computer\u2010assisted detection of systolic murmurs associated with hypertrophic cardiomyopathy: a pilot study","volume":"31","author":"Watrous RL","year":"2004","journal-title":"Tex Heart Inst J"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00454-9"},{"key":"e_1_2_1_13_2","unstructured":"TuchindaC ThompsonWR. Cardiac auscultatory recording database: delivering heart sounds through the Internet. InProceeding AMIA Symposium Washington D.C.2001;716\u2013720."},{"key":"e_1_2_1_14_2","first-page":"2877","article-title":"Detection of the first and second heart sound using probabilistic models","volume":"25","author":"Gamero LG","year":"2003","journal-title":"25th Annual International Conference of the IEEE EMBS, Cancun, Mexico."},{"key":"e_1_2_1_15_2","unstructured":"OskiperT WatrousRL. Detection of the first heart sound using a time\u2010delay neural network computers in cardiology Memphis TN September 22\u201325 2002."},{"key":"e_1_2_1_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.acra.2004.04.014"}],"container-title":["Clinical Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fclc.20185","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.20185","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T16:37:27Z","timestamp":1699979847000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/clc.20185"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,2]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2008,2]]}},"alternative-id":["10.1002\/clc.20185"],"URL":"https:\/\/doi.org\/10.1002\/clc.20185","archive":["Portico"],"relation":{},"ISSN":["0160-9289","1932-8737"],"issn-type":[{"value":"0160-9289","type":"print"},{"value":"1932-8737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,2]]}}}