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RESEARCH ARTICLE
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Are we missing opportunities to detect acute rheumatic fever and rheumatic heart disease in hospital care? A multijurisdictional cohort study

John A. Woods https://orcid.org/0000-0003-3006-8500 A * , Nita Sodhi-Berry https://orcid.org/0000-0003-3406-6019 B , Bradley R. MacDonald https://orcid.org/0000-0003-2812-0744 B C D , Anna P. Ralph https://orcid.org/0000-0002-2253-5749 E , Carl Francia https://orcid.org/0000-0002-9552-8814 F , Ingrid Stacey https://orcid.org/0000-0002-3032-6031 B and Judith M. Katzenellenbogen https://orcid.org/0000-0001-5287-5819 B C
+ Author Affiliations
- Author Affiliations

A Western Australian Centre for Rural Health, School of Allied Health, The University of Western Australia (M315), 35 Stirling Highway, Perth, WA 6009, Australia.

B School of Population and Global Health, The University of Western Australia, WA, Australia.

C Telethon Kids Institute, The University of Western Australia, WA, Australia.

D Department of General Paediatrics, Perth Children’s Hospital, WA, Australia.

E Menzies School of Health Research, Charles Darwin University, NT, Australia.

F School of Health and Rehabilitation Sciences, The University of Queensland, Qld, Australia.

* Correspondence to: john.woods@uwa.edu.au

Australian Health Review https://doi.org/10.1071/AH23273
Submitted: 20 December 2023  Accepted: 9 July 2024  Published: 23 July 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

Objective

This study aimed to investigate potential missed diagnoses of acute rheumatic fever and rheumatic heart disease during hospital-based care among persons subsequently identified with these conditions.

Methods

This retrospective cohort study used linked emergency department and inpatient administrative records from Queensland, Northern Territory, South Australia, and New South Wales during 2003–2018 (varying between jurisdictions by completeness of data) of all persons first identified with acute rheumatic fever or rheumatic heart disease while aged 8–24 years. Using coded discharge diagnoses from the preceding 3 years, we identified presentations (e.g. joint pains or heart murmur without specific identified cause) that potentially mimic and thereby represent a missed opportunity to detect acute rheumatic fever or rheumatic heart disease. Sociodemographic factors associated with experiencing ≥1 mimic diagnoses were investigated using multivariable logistic regression models.

Results

Among 1855 persons, 65 (3.5%) (using narrow diagnostic inclusions) and 146 (7.9%) (with broad inclusions) experienced ≥1 mimic diagnosis. Joint disorders predominated. Mimics categorised as ‘high-likelihood’ (most specific) were more frequent among persons subsequently diagnosed as young adults (18–24 years) than as children (8–12 years) (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.34–4.47), and those from low-risk ethnic groups (including Australian-born non-Indigenous persons) compared with Aboriginal and Torres Strait Islander peoples (OR 2.44, 95% CI 1.02–5.85).

Conclusion

Missed opportunities to detect acute rheumatic fever and rheumatic heart disease continue to occur in Australian hospitals, and present disproportionately among persons from demographic groups considered to be at low risk, suggesting the need for enhanced clinical suspicion in these groups.

Keywords: Australia, cohort studies, delayed diagnosis, hospital medicine, missed diagnosis, rheumatic fever, rheumatic heart disease, routinely collected health data.

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