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G92(P) Paediatric cardiac murmur guideline for the children’s emergency department
  1. P Venugopalan,
  2. M Ranaweera
  1. Paediatrics, Brighton and Sussex University Hospitals, Brighton, UK


Aim To develop a paediatric cardiac murmur guideline for a Children’s emergency department (CED), following mismanagement of 2 cases of heart murmurs in children. Currently there is no national guideline in place.

Methods Electronic databases Medline, Embase, Cochrane Cinahl, Psycinfo, Amed, British nursing index, DARE and CENTRAL were searched using title/abstract terms and subject headings: heart/cardio/cardia/murmur/sound AND diagnosis/assessment/evaluation/examination. Results were limited to children aged 0–18 years and no limitations placed on date or language. The results were exported on to Mendeley workstation and analysed.

Results Medline returned 1204 results, Embase (1168), Cochrane (0), Cinahl (131), Psycinfo (15), Amed (13), British nursing index (5), DARE (0) and CENTRAL (8). When duplicates were removed 2533 results remained from which 560 articles were selected according to suitability. Among these 100 original papers were fully accessed and reviewed. Based on the available evidence a guideline triaging patients into a traffic-light system according to clinical severity with an algorithm for investigation was developed, taking into account patient feedback and opinions from experts in the field (Figures 1 and 2).

Abstract G92(P) Figure 1

Neonatal murmur algorithm

Abstract G92(P) Figure 2

Older children murmur algorithm

Conclusion A new, easy to follow guideline has been implemented, which will aid clinicians to confidently triage children presenting with murmurs according to clinical need and guide appropriate management. This will promote quality of care and patient safety, and facilitate the management of children with murmurs who attend the CED.

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