Automated point-of-care identification of innocent Still's murmur in children

项目摘要 拟议的研究和技术转让工作的总体目标是开发一种低成本、 用于Still杂音自动识别的基于移动的设备的床旁技术， 儿童期最常见的无害心脏杂音。这本小说 技术可以减少目前50多万儿童不必要的转诊率， 儿科心脏病专家由初级保健提供者每年在美国。在第一阶段， AusculTech Dx和儿童国家医疗中心开发了一种机器学习算法 能够以高准确性识别Still杂音（90%灵敏度，99%特异性）。到 使数字记录，必要的计算机化杂音分析，我们还开发了一个 连接到智能手机的数字听诊器，其性能相当于 商用听诊器我们设想的产品，称为StethAid，是这本小说的结合 数字听诊器和智能手机应用程序（app）。在成功完成了第一阶段 性能里程碑，我们现在建议全面开发StethAid，并进行多中心 试验通过以下三个具体目标：（1）开发和测试临床级数字 听诊器，（2）开发全功能软件应用程序，（3）进行多中心试验， 斯蒂尔杂音鉴定。对于多中心试验，我们扩大了合作， 包括波士顿儿童医院和沃尔特里德国家军事医疗中心。我们 第二阶段的交付成果是一个经过领先的儿科心脏病专家验证的技术平台， 已准备好寻求监管部门的批准，在PCP办公室部署和商业化。作为 StethAid是一个决策支持系统，它可以使PCP准确地识别斯蒂尔杂音 从而减少大量不必要的专科转诊。这应该可以节省 医疗保健系统每年投入数亿美元，使儿科心脏病专家能够专注于 对病情严重的病人，并保护健康的儿童及其家人免受 不必要的焦虑、不便和看儿科心脏病专家的费用。

PROJECT SUMMARY The overall goal of the proposed research and technology transfer effort is to develop a low-cost, point-of-care, mobile device-based technology for automated identification of Still's murmur, the most common innocent (benign and harmless) heart murmur of childhood. This novel technology could reduce the current rate of over half a million children unnecessarily referred to pediatric cardiologists by primary care providers each year in the United States. In Phase I, AusculTech Dx and Children's National Medical Center developed a machine-learning algorithm capable of identifying Still's murmur with high accuracy (90% sensitivity, 99% specificity). To enable digital recording, essential for computerized murmur analysis, we also developed a digital stethoscope that connects to a smartphone and is equivalent in performance to a commercial stethoscope. Our envisioned product, called StethAid, is a combination of this novel digital stethoscope and a smartphone application (app). Having successfully met the Phase I performance milestones, we now propose to fully develop StethAid and conduct a multicenter trial through the following three specific aims: (1) develop and test a clinical-grade digital stethoscope, (2) develop fully feature software app, (3) conduct a multicenter trial of automated Still's murmur identification. For the multicenter trial, we have expanded our collaboration to include Boston Children's Hospital and Walter Reed National Military Medical Center. Our deliverable for Phase II is a technology platform validated by leading pediatric cardiologists that is ready for seeking regulatory approvals, deployment at PCP offices, and commercialization. As a decision support system, StethAid could empower PCPs to identify Still's murmur accurately and thus reduce the huge number of unnecessary specialist referrals. This should save the healthcare system hundreds of millions of dollars annually, allow pediatric cardiologists to focus on patients with serious conditions, and protect healthy children and their families from the unnecessary anxiety, inconvenience, and expense of seeing a pediatric cardiologist.