Diagnostic Accuracy of a Clinical Scoring Scheme in Childhood Heart Failure.

BACKGROUND

Heart failure remains a major health problem. But its early diagnosis remains a significant challenge especially among the Paediatric population. A standardized highly sensitive and specific clinical basis of diagnosis requiring no sophisticated equipment readily elicitable at the patients beside at presentation is required.

OBJECTIVE

The study set out to determine the accuracy of a clinical scoring scheme for the diagnosis of heart failure in infants in Ibadan, Nigeria, using B-type natriuretic peptide (BNP) as gold standard.

METHODOLOGY

Forty-five consecutive infants admitted into the Paediatric wards of the University College Hospital and the Adeoyo Maternity Teaching Hospital in Ibadan, Nigeria were evaluated with the Ibadan Childhood Heart Failure Index (ICHFI) and those with clinical score of > 3 were recruited. Their plasma BNP levels and those of 45 age-matched controls were also measured.

RESULTS

There was a strong positive correlation (0.920) between the ICHFI scores and plasma BNP values (rs = 0.920, P = 0.000). At a cut-off score of 2, the ICHFI has a sensitivity of 97.6%, specificity of 89.8%, a positive predictive value of 88.9% and a negative predictive value of 97.8%. The receiver operating characteristic curve plotted had an AUC of 0.978 at the 95% CI, 0.951-1.000; P < 0.001.

CONCLUSION

The ICHFI was found to be an accurate tool for the diagnosis of heart failure in infants and it is therefore recommended for use in primary care and resource challenged settings for the rapid diagnosis, grading of the severity of heart failure and monitoring of treatment.