One hundred children, ages 1 month to 15 years, presenting with a new
heart murmur were evaluated with chest x-ray (CXR), EKG, and cardiac
ECHO.1 The ECHO was taken as the gold standard.
The sensitivity of CXR compared to ECHO was 43% and the specificity
was 82%. Therefore, the positive likelihood ratio (LR (+)) is 2.5 and
the LR (-) is 0.75.
For patients with an abnormal x-ray, the test is minimally useful, but
for the result we really care about (a negative CXR), the test is basically
Thus, for patients with an asymptomatic heart murmur, referral to a
cardiologist for consideration of a cardiac ECHO is the best option.