Providencia Rui, Aali Ghazaleh, Zhu Fang, Katairo Thomas, Ahmad Mahmood, Bray Jonathan Jh, Pelone Ferruccio, Marijon Eloi, Cassandra Miryan, Celermajer David S, Shokraneh Farhad
GENEs health and social care evidence SYnthesiS unit, Institute of Health Informatics, University College, London, UK.
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
Commun Med (Lond). 2025 Aug 12;5(1):348. doi: 10.1038/s43856-025-01023-1.
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.
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).
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.
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.
风湿性心脏病是急性风湿热的长期后遗症，在非洲和世界其他中低收入地区仍然是一个普遍的公共卫生问题。在高流行地区诊断急性风湿热并应用改良琼斯标准仍然具有挑战性。
我们评估了（i）疑似急性风湿热的儿童、青少年和成人中简化诊断算法的诊断准确性，以及（ii）不同诊断标准对风湿性心脏病发展的影响（国际前瞻性系统评价注册库编号：CRD42022344077）。检索了MEDLINE、Embase和会议论文引文索引 - 科学数据库中的相关报告（日期：2025年3月15日）。
我们共识别出12,075条记录，三项研究（四份报告）符合我们的纳入标准。仅在社区卫生中心层面使用临床数据的简化诊断算法（曲线下面积0.69，敏感性66%，特异性68%），或在地区级设施中增加12导联心电图和简单实验室检查的算法（曲线下面积0.76，敏感性77%，特异性为67%），其表现不如在国家转诊医院使用全套实验室检查和超声心动图的模型（曲线下面积0.91，敏感性84%，特异性87%）。使用无超声心动图结果的改良琼斯标准会导致敏感性显著降低（敏感性79%，特异性100%，曲线下面积0.90）。在高流行地区，未达到完整改良琼斯标准的儿童和年轻人中，有2.5% - 5%会发展为风湿性心脏病。
在无法进行超声心动图检查和实验室检查的地区简化改良琼斯标准可能会导致急性风湿热诊断不足。一些未达到明确急性风湿热诊断的改良琼斯标准的患者仍可能发展为风湿性心脏病。
