Cardiac screening by computerized auscultation.

U NRECOGNIZED organic heart disease among school children has been a concern of public health officials for many years. Detection of these cases, estimated at approximately two per 1,000 children, implies the opportunity for proper therapy which could not otherwise be contemplated. In an era of effective antimicrobial prophylaxis and successful surgical cardiac intervention the early discovery of such cases is vital to an improved prognosis in terms of disability and ultimate survival. However, finding cases of previously unsuspected heart disease hidden among large numbers of presumably normal school children can be a most difficult and vexing task. In the City of New York 350.000 school children are routinely examined by physicians every year. Approximately 4,500 of these are found to have some suspicious cardiac findings and are referred to cardiologists for additional study and evaluation. Yet more than 70 per cent of those referred are found ultimately to have Ino heart disease. Because of the expenditure in time and money, as wvell as the difficulty in obtaining sufficient numbers of physicians for this enormous number of examinations, we have been interested in exploring new methods of mass physical examination. If a reliable technique could indeed be found t^ screen large numbers of school children without utilizing sorely needed physicians, considerable savings of time, money, and professional talent might result. Moreover, the large number of children presently being referred for cardiac consultation following initial examination might be significantly reduced. This method must be able to "recognize" innocent heart murmurs and be able to distinguish them from those due to organic heart disease. The use of such a method in geographical areas-where enough physicians are simply not available for mass cardiac screening examinations-would seem to have important public health implications. The application of modern electronic technology to the mass cardiac screening of school children has resulted in a new field for development and research. Mass cardiac screenings to discover previously unsuspected heart disease have been done with the use of tape recordings.1-4 However, because of the intrinsic difficulties in recording heart sounds and murmurs on tape-and the fatigue of physicians who listen to large numbers of them-the method proved to be impractical. We have employed a new instrument