Pediatric humanitarian cardiovascular screening often poses unique challenges in both time and patient numbers. The most effective process remains unclear.

As part of ongoing CHD screening in Mongolia, a team (PS) of PNPs, internists, pediatricians and medical students evaluated available children in the Hovskul region over five days. Demographic and clinical information was collected. A pediatric cardiologist (PC) evaluated a 5% random sample of those screened. Children with pathologic murmurs (PM) were referred for ECHO.

Of 1171 children evaluated, 48% were male, aged 9.2 ± 4.4 years. A murmur was detected in 14.9%, whereas a PM was found in 4.4%. Pulse oximetry did not significantly discriminate among those with CHD (SaO2 = 94.2±6.6 CHD+, 96.8±1.8% CHD-), though it did identify those with cyanotic forms (SaO2 = 86.5±7.7%, p<0.01). Likewise, family history of CHD and prior notation of a murmur (innocent or pathologic), did not aid in CHD identification. PC review of 60 children screened by PS showed 80% agreement. For the 12 children in whom disagreement occurred, 10 were felt to have a PM by PS, but an innocent murmur by PC. For two patients with an innocent murmur by PS, but PM by PC, one had bicuspid aortic valve and one had a moderate-sized ASD.

PS may be used effectively to screen large cohorts of children for CHD. The added utility of pulse oximetry or history, in this screening setting, appears minimal. Most concerning among missed diagnoses is ASD; additional testing (such as ECG) may be warranted.