The World Heart Federation criteria raise the threshold of diagnosis for mild rheumatic heart disease: Three reviewers are better than one
| Autor: | Rachel Webb, Nigel Wilson, Karishma Sidhu, Nicola Culliford-Semmens, Ross Nicholson, Elizabeth Tilton, John Stirling |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Heart disease 030204 cardiovascular system & hematology 03 medical and health sciences Cardiologists 0302 clinical medicine Internal medicine medicine Humans Mass Screening 030212 general & internal medicine Child business.industry Significant difference Rheumatic Heart Disease Guideline medicine.disease Echocardiography Doppler Female Open label Cardiology and Cardiovascular Medicine business Reporting system Kappa New Zealand |
| Zdroj: | International Journal of Cardiology. 291:112-118 |
| ISSN: | 0167-5273 |
| Popis: | Background The World Heart Federation (WHF) criteria, published in 2012, provided an evidence-based guideline for the minimal diagnosis of echocardiographically-detected RHD. Primary aim of the study was to determine whether use of the WHF criteria altered the threshold for the diagnosis of echocardiographically-detected RHD compared with the previous WHO/NIH criteria. A secondary aim was to explore the utility of a three reviewer reporting system compared to a single or two reviewer reporting structure. Methods 144 de-identified echocardiograms (RHD, congenital valvar abnormality, physiological valvar regurgitation) were independently reported using the WHF criteria by two reviewers blinded to the previous WHO/NIH diagnosis. If there was discordance between the two reviewers, a third cardiologist independently performed a tie-breaker review. Results There was a 21% reduction of cases classified as RHD using the WHF criteria compared to the modified WHO/NIH criteria (68 cases compared to 86, p = 0.04). There was a 60% consensus across the different diagnostic categories with 2 reviewers, 89% majority agreement with 3 reviewers. 11% required an open label discussion. There was moderate agreement between 2 reviewers for any RHD, kappa 0.57 (CI 0.44–0.70), with no significant difference in agreement between the different categories. Conclusion The WHF criteria have raised the threshold for the diagnosis of RHD compared to the WHO/NIH criteria. However, inter-reporter variability of the WHF criteria is high. A three reviewer system is likely more accurate than a single or two reporter system for the diagnosis of mild RHD. This has resource implications for echocardiographic screening programmes. |
| Databáze: | OpenAIRE |
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