Diagnostic test accuracy of simplified algorithms for diagnosing acute rheumatic fever: a systematic review
Abstract Background Rheumatic heart disease, the long-term sequel to acute rheumatic fever, remains a prevalent public health problem in Africa and other low to middle-income regions of the world. Diagnosing acute rheumatic fever and using the modified Jones criteria in high-prevalence areas remains...
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Nature Portfolio
2025-08-01
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| Series: | Communications Medicine |
| Online Access: | https://doi.org/10.1038/s43856-025-01023-1 |
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| author | Rui Providencia Ghazaleh Aali Fang Zhu Thomas Katairo Mahmood Ahmad Jonathan JH Bray Ferruccio Pelone Eloi Marijon Miryan Cassandra David S. Celermajer Farhad Shokraneh |
| author_facet | Rui Providencia Ghazaleh Aali Fang Zhu Thomas Katairo Mahmood Ahmad Jonathan JH Bray Ferruccio Pelone Eloi Marijon Miryan Cassandra David S. Celermajer Farhad Shokraneh |
| author_sort | Rui Providencia |
| collection | DOAJ |
| description | Abstract Background Rheumatic heart disease, the long-term sequel to acute rheumatic fever, remains a prevalent public health problem in Africa and other low to middle-income regions of the world. Diagnosing acute rheumatic fever and using the modified Jones criteria in high-prevalence areas remains challenging. Methods We assessed the (i) diagnostic accuracy of simplified diagnostic algorithms among children, adolescents, and adults with suspected acute rheumatic fever, and (ii) the impact of different diagnostic criteria on the development of rheumatic heart disease (PROSPERO CRD42022344077). The MEDLINE, Embase, and Conference Proceedings Citation Index-Science were searched for relevant reports (date: 15th March 2025). Results Here we identify 12,075 records, and three studies (four reports) meeting our eligibility criteria. Simplified diagnostic algorithms using only clinical data at community health centre-level (AUC 0.69, sensitivity 66% and specificity 68%), or adding 12-lead electrocardiogram and simple laboratory investigations at district-level facilities (AUC 0.76, sensitivity 77% and specificity 67%) perform worse than models including the full-set of laboratory investigations and echocardiography at National referral hospitals (AUC 0.91, sensitivity 84% & specificity 87%). Using modified Jones criteria without echocardiography results in an important loss of sensitivity (sensitivity 79%, specificity 100% & AUC 0.90). Progression to rheumatic heart disease is reported in 2.5–5% of children and young adults in high-prevalence areas who do not meet the full modified Jones criteria. Conclusions Simplification of the modified Jones criteria in areas without access to echocardiography and laboratory investigations may lead to underdiagnosis of acute rheumatic fever. Some patients who do not meet the modified Jones criteria for definite acute rheumatic fever diagnosis may still progress to develop rheumatic heart disease. |
| format | Article |
| id | doaj-art-fa5fa78c4f7a4478b7688020ee04d23b |
| institution | DOAJ |
| issn | 2730-664X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Communications Medicine |
| spelling | doaj-art-fa5fa78c4f7a4478b7688020ee04d23b2025-08-20T03:06:04ZengNature PortfolioCommunications Medicine2730-664X2025-08-01511910.1038/s43856-025-01023-1Diagnostic test accuracy of simplified algorithms for diagnosing acute rheumatic fever: a systematic reviewRui Providencia0Ghazaleh Aali1Fang Zhu2Thomas Katairo3Mahmood Ahmad4Jonathan JH Bray5Ferruccio Pelone6Eloi Marijon7Miryan Cassandra8David S. Celermajer9Farhad Shokraneh10GENEs health and social care evidence SYnthesiS unit, Institute of Health Informatics, University CollegeDepartment of Evidence Synthesis, Systematic Review Consultants LTDDepartment of Biostatistics, Systematic Review Consultants LTDDepartment of Biostatistics, Systematic Review Consultants LTDGENEs health and social care evidence SYnthesiS unit, Institute of Health Informatics, University CollegeGENEs health and social care evidence SYnthesiS unit, Institute of Health Informatics, University CollegeGENEs health and social care evidence SYnthesiS unit, Institute of Health Informatics, University CollegeParis Cardiovascular Research Centre, INSERM U970, European Georges Pompidou HospitalCardiology Department, Hospital Dr. Ayres de MenezesFaculty of Medicine and Health, The University of SydneyGENEs health and social care evidence SYnthesiS unit, Institute of Health Informatics, University CollegeAbstract Background Rheumatic heart disease, the long-term sequel to acute rheumatic fever, remains a prevalent public health problem in Africa and other low to middle-income regions of the world. Diagnosing acute rheumatic fever and using the modified Jones criteria in high-prevalence areas remains challenging. Methods We assessed the (i) diagnostic accuracy of simplified diagnostic algorithms among children, adolescents, and adults with suspected acute rheumatic fever, and (ii) the impact of different diagnostic criteria on the development of rheumatic heart disease (PROSPERO CRD42022344077). The MEDLINE, Embase, and Conference Proceedings Citation Index-Science were searched for relevant reports (date: 15th March 2025). Results Here we identify 12,075 records, and three studies (four reports) meeting our eligibility criteria. Simplified diagnostic algorithms using only clinical data at community health centre-level (AUC 0.69, sensitivity 66% and specificity 68%), or adding 12-lead electrocardiogram and simple laboratory investigations at district-level facilities (AUC 0.76, sensitivity 77% and specificity 67%) perform worse than models including the full-set of laboratory investigations and echocardiography at National referral hospitals (AUC 0.91, sensitivity 84% & specificity 87%). Using modified Jones criteria without echocardiography results in an important loss of sensitivity (sensitivity 79%, specificity 100% & AUC 0.90). Progression to rheumatic heart disease is reported in 2.5–5% of children and young adults in high-prevalence areas who do not meet the full modified Jones criteria. Conclusions Simplification of the modified Jones criteria in areas without access to echocardiography and laboratory investigations may lead to underdiagnosis of acute rheumatic fever. Some patients who do not meet the modified Jones criteria for definite acute rheumatic fever diagnosis may still progress to develop rheumatic heart disease.https://doi.org/10.1038/s43856-025-01023-1 |
| spellingShingle | Rui Providencia Ghazaleh Aali Fang Zhu Thomas Katairo Mahmood Ahmad Jonathan JH Bray Ferruccio Pelone Eloi Marijon Miryan Cassandra David S. Celermajer Farhad Shokraneh Diagnostic test accuracy of simplified algorithms for diagnosing acute rheumatic fever: a systematic review Communications Medicine |
| title | Diagnostic test accuracy of simplified algorithms for diagnosing acute rheumatic fever: a systematic review |
| title_full | Diagnostic test accuracy of simplified algorithms for diagnosing acute rheumatic fever: a systematic review |
| title_fullStr | Diagnostic test accuracy of simplified algorithms for diagnosing acute rheumatic fever: a systematic review |
| title_full_unstemmed | Diagnostic test accuracy of simplified algorithms for diagnosing acute rheumatic fever: a systematic review |
| title_short | Diagnostic test accuracy of simplified algorithms for diagnosing acute rheumatic fever: a systematic review |
| title_sort | diagnostic test accuracy of simplified algorithms for diagnosing acute rheumatic fever a systematic review |
| url | https://doi.org/10.1038/s43856-025-01023-1 |
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