A Retrospective Linked Data Analysis of Acute Rheumatic Fever and Rheumatic Heart Disease Diagnoses in Children Aged Under Five Years in Australia, 2001-2017.
Jamie Cransberg, Judith Katzenellenbogen, Bo Remenyi and 3 others
PMID 41531348WHAT IT FOUND
Acute rheumatic fever and rheumatic heart disease were first diagnosed in 180 Australian children under 5 years.
Most were Indigenous or very remote, and only 69.4% were notified to registers, so follow-up and preventive treatment may have been missed.
Key findings
01Of 2382 children under 15 years with first-ever acute rheumatic fever or rheumatic heart disease, 180 (7.6%) were diagnosed before age 5.
02Under-5 acute rheumatic fever or rheumatic heart disease cases were frequently Indigenous (87.2%), very remote (50.6%) or most disadvantaged (66.7%), and only 69.4% were notified to registers.
03When rheumatic heart disease was diagnosed before age 5, 44.9% were mild compared with 57.5% of 5-9-year-olds and 63.2% of 10-14-year-olds, and 31.0% of under-5 acute rheumatic fever or rheumatic heart disease cases were never notified.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used administrative hospital, emergency department, register and death records, not clinical records designed for research. New South Wales was excluded because rheumatic heart disease register data were not complete for the whole period. Hospital-only cases lacked detailed clinical information, including rheumatic heart disease severity. ICD-10-AM coding can misclassify rheumatic heart disease, although a validated algorithm was used. No primary care data were available, so care and prevention outside hospital could not be assessed. Emergency department presentations were a crude marker of healthcare contact and may reflect local access and retrieval practices. Small numbers for some events, such as trauma hospitalisations, prevented multivariable analysis. The study cannot show why under-5 cases were not registered or whether they still received follow-up and prophylaxis. It cannot prove that injury or infection caused acute rheumatic fever or rheumatic heart disease. The analysis could not fully describe the burden in recently arrived migrants because migration and ethnicity data were incomplete.
Declared interests
The study was supported by National Health and Medical Research Council project grant 1146525 and National Heart Foundation Future Leader Fellowship 108106 and Postdoctoral Fellowship 110335. The supplied text does not report author conflicts of interest.
The easy way to misread this
Do not assume that children not notified to registers received no care. The study only shows register notification status and does not include primary care records, so it cannot confirm whether follow-up or preventive treatment was missed.