Please use this identifier to cite or link to this item: http://docs.prosentient.com.au/prosentientjspui/handle/1/10303
Title: Focused cardiac ultrasound screening for rheumatic heart disease by briefly trained health workers: a study of diagnostic accuracy.
Authors: Engelman, Daniel
Kado, Joseph H
Reményi, Bo
Colquhoun, Samantha M
Carapetis, Jonathan R
Donath, Susan
Wilson, Nigel J
Steer, Andrew C
Affiliation: Centre for International Child Health, University of Melbourne, Royal Children's Hospital, Melbourne, VIC, Australia; Group A Streptococcal Research, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia. Electronic address: daniel.engelman@rch.org.au..
College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji; Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji..
Royal Darwin Hospital, Tiwi, NT, Australia; Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia..
Centre for International Child Health, University of Melbourne, Royal Children's Hospital, Melbourne, VIC, Australia; Group A Streptococcal Research, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia; Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia..
Telethon Kids Institute, University of Western Australia, West Perth, WA, Australia; Princess Margaret Hospital for Children, Subiaco, WA, Australia..
Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Melbourne, VIC, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia..
Starship Hospital, Auckland, New Zealand; University of Auckland, Auckland, New Zealand..
Centre for International Child Health, University of Melbourne, Royal Children's Hospital, Melbourne, VIC, Australia; Group A Streptococcal Research, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia..
Issue Date: 2016
Citation: The Lancet. Global health 2016; 4(6): e386-94
Abstract: Echocardiographic screening for rheumatic heart disease (RHD) can identify individuals with subclinical disease who could benefit from antibiotic prophylaxis. However, most settings have inadequate resources to implement conventional echocardiography and require a feasible, accurate screening method. We aimed to investigate the accuracy of screening by non-expert operators using focused cardiac ultrasound (FoCUS). In this prospective study of diagnostic accuracy, we recruited schoolchildren aged 5 to 15 years in Fiji to undergo two blinded tests. The index test was a FoCUS assessment of mitral and aortic regurgitation, performed by nurses after an 8-week training programme. The reference standard was the diagnosis of RHD by a paediatric cardiologist, based on a standard echocardiogram performed by a skilled echocardiographer. The primary outcome was the accuracy of the index test with use of the most sensitive criteria (any regurgitation). We included 2004 children in the study. The index tests were done between September, 2012, and September, 2013, by seven nurses in eight schools in Fiji. The diagnostic accuracy of the screening test (area under receiver operator characteristic curve) was 0·89 (95% CI 0·83-0·94). When the primary cut-off point (any regurgitation) was used for analysis, sensitivity was 84·2% (72·1-92·5) and specificity was 85·6% (83·9-87·1). The sensitivity of individual nurses ranged from 66·7% to 100% and specificity 74·0% to 93·7%. Screening by briefly trained nurses using FoCUS was accurate for the diagnosis of RHD. Refinements to training and screening test methods should be studied in a range of settings, and in parallel with investigations of the long-term clinical and cost-effectiveness of screening for RHD. Cure Kids, New Zealand; the Fiji Water Foundation provided funding for portable ultrasound equipment; see acknowledgments for further details of funders.
URI: http://docs.prosentient.com.au/prosentientjspui/handle/1/10303
DOI: 10.1016/S2214-109X(16)30065-1
Type: Journal Article
Research Support, Non-U.S. Gov't
Subjects: Adolescent
Aortic Valve Insufficiency
Child
Child, Preschool
Female
Fiji
Health Resources
Heart Valves
Humans
Male
Mass Screening
Mitral Valve Insufficiency
Prospective Studies
ROC Curve
Reference Values
Rheumatic Heart Disease
Sensitivity and Specificity
Ultrasonography
Clinical Competence
Inservice Training
Nurses
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