| Autor: |
de Loizaga SR; Cincinnati Children's Hospital Medical Center Cincinnati OH., Arthur L; University of Arkansas for Medical Sciences/Arkansas Children's Hospital Little Rock AR., Arya B; Seattle Children's Hospital/University of Washington School of Medicine Seattle WA., Beckman B; Nationwide Children's Hospital Columbus OH., Belay W; Monroe Carell Jr Children's Hospital at Vanderbilt Nashville TN., Brokamp C; Cincinnati Children's Hospital Medical Center Cincinnati OH.; University of Cincinnati Cincinnati OH., Hyun Choi N; Morgan Stanley Children's Hospital of New York PresbyterianColumbia University Medical Center New York NY., Connolly S; Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL., Dasgupta S; Children's Healthcare of AtlantaEmory University Atlanta GA., Dibert T; University of Florida Health, Shands Children's Hospital Gainesville FL., Dryer MM; University of Rochester Medical Center Rochester NY., Gokanapudy Hahn LR; Washington University School of Medicine, St. Louis MO., Greene EA; University of New Mexico Albuquerque NM., Kernizan D; Nemours/Alfred I. duPont Hospital for Children Wilmington DE., Khalid O; Nationwide Children's Hospital Columbus OH., Klein J; Children's National Hospital Washington DC., Kobayashi R; Boston Children's Hospital Boston MA., Lahiri S; Texas Children's Hospital Houston TX., Lorenzoni RP; Children's Hospital at Montefiore Bronx NY., Otero Luna A; Yale New Haven Medical Center New Haven CT., Marshall J; Children's Mercy Hospital Kansas City MO., Millette T; University of Mississippi Jackson MS., Moore L; University of Mississippi Jackson MS., Muhamed B; Children's National Hospital Washington DC., Murali M; Children's National Hospital Washington DC., Parikh K; Nicklaus Children's Hospital Miami FL., Sanyahumbi A; Texas Children's Hospital Houston TX., Shakti D; University of Mississippi Jackson MS., Stein E; Seattle Children's Hospital/University of Washington School of Medicine Seattle WA., Shah S; Children's Mercy Hospital Kansas City MO., Wilkins H; University of Arkansas for Medical Sciences/Arkansas Children's Hospital Little Rock AR., Windom M; Duke Children's Hospital & Health Center Durham NC., Wirth S; Cincinnati Children's Hospital Medical Center Cincinnati OH., Zimmerman M; Children's National Hospital Washington DC., Beck AF; Cincinnati Children's Hospital Medical Center Cincinnati OH.; University of Cincinnati Cincinnati OH., Ollberding N; Cincinnati Children's Hospital Medical Center Cincinnati OH.; University of Cincinnati Cincinnati OH., Sable C; Children's National Hospital Washington DC., Beaton A; Cincinnati Children's Hospital Medical Center Cincinnati OH.; University of Cincinnati Cincinnati OH. |
| Abstrakt: |
Background Recent evaluation of rheumatic heart disease (RHD) mortality demonstrates disproportionate disease burden within the United States. However, there are few contemporary data on US children living with acute rheumatic fever (ARF) and RHD. Methods and Results Twenty-two US pediatric institutions participated in a 10-year review (2008-2018) of electronic medical records and echocardiographic databases of children 4 to 17 years diagnosed with ARF/RHD to determine demographics, diagnosis, and management. Geocoding was used to determine a census tract-based socioeconomic deprivation index. Descriptive statistics of patient characteristics and regression analysis of RHD classification, disease severity, and initial antibiotic prescription according to community deprivation were obtained. Data for 947 cases showed median age at diagnosis of 9 years; 51% and 56% identified as male and non-White, respectively. Most (89%) had health insurance and were first diagnosed in the United States (82%). Only 13% reported travel to an endemic region before diagnosis. Although 96% of patients were prescribed secondary prophylaxis, only 58% were prescribed intramuscular benzathine penicillin G. Higher deprivation was associated with increasing disease severity (odds ratio, 1.25; 95% CI, 1.08-1.46). Conclusions The majority of recent US cases of ARF and RHD are endemic rather than the result of foreign exposure. Children who live in more deprived communities are at risk for more severe disease. This study demonstrates a need to improve guideline-based treatment for ARF/RHD with respect to secondary prophylaxis and to increase research efforts to better understand ARF and RHD in the United States. |
Plný text