222 children with newly dx'd heart murmur evaluated with EKG and echo (Arch. Pediatr. Adolesc. Med 150:169, 1996-JW)

  1. 33% had true cardiac disease
  2. Clinical exam would have led to error in 7% of kids (4% false-pos; 3% false neg)
  3. Independent predictors of sig, disease:
  1. Pansystolic murmur
  2. III/VI or louder murmur
  3. Murmur at left upper sternal border
  4. Early or midsystolic click
  5. Abnormal S2