Engelman, Daniel

Kado, Joseph H

Reményi, Bo

Colquhoun, Samantha M

Carapetis, Jonathan R

Wilson, Nigel J

Donath, Susan

Steer, Andrew C

2016-02-01

Echocardiographic screening for rheumatic heart disease (RHD) has the potential to detect subclinical cases for secondary prevention, but is constrained by inadequate human resources in most settings. Training non-expert health workers to perform focused cardiac ultrasound (FoCUS) may enable screening at a population-level. We aimed to evaluate the quality and agreement of FoCUS for valvular regurgitation by briefly trained health workers. Seven nurses participated in an eight week training program in Fiji. Nurses performed FoCUS on 2018 children aged five to 15 years, and assessed any valvular regurgitation. An experienced pediatric cardiologist assessed the quality of ultrasound images and measured any recorded regurgitation. The assessment of the presence of regurgitation and measurement of the longest jet by the nurse and cardiologist was compared, using the Bland-Altman method. The quality of FoCUS overall was adequate for diagnosis in 96.6%. There was substantial agreement between the cardiologist and the nurses overall on the presence of mitral regurgitation (κ = 0.75) and aortic regurgitation (κ = 0.61) seen in two views. Measurements of mitral regurgitation by nurses and the cardiologist were similar (mean bias 0.01 cm; 95% limits of agreement -0.64 to 0.66 cm). After brief training, health workers with no prior experience in echocardiography can obtain adequate quality images and make a reliable assessment on the presence and extent of valvular regurgitation. Further evaluation of the imaging performance and accuracy of screening by non-expert operators is warranted, as a potential population-level screening strategy in high prevalence settings.

Centre for International Child Health, University of Melbourne, Parkville, Victoria, Australia. Daniel.Engelman@rch.org.au.. Group A Streptococcal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia. Daniel.Engelman@rch.org.au.. Royal Children's Hospital, Parkville, Victoria, Australia. Daniel.Engelman@rch.org.au..

Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji. Joseph_Kado@yahoo.co.uk.. College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji. Joseph_Kado@yahoo.co.uk..

Royal Darwin Hospital, Tiwi, Northern Territory, Australia. Bo.Remenyi@menzies.edu.au.. Menzies School of Health Research, Casuarina, Northern Territory, Australia. Bo.Remenyi@menzies.edu.au..

Centre for International Child Health, University of Melbourne, Parkville, Victoria, Australia. Samantha.Colquhoun@rch.org.au.. Group A Streptococcal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia. Samantha.Colquhoun@rch.org.au.. Menzies School of Health Research, Casuarina, Northern Territory, Australia. Samantha.Colquhoun@rch.org.au..

Telethon Kids Institute, University of Western Australia, West Perth, Western Australia, Australia. Jonathan.Carapetis@telethonkids.org.au.. Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia. Jonathan.Carapetis@telethonkids.org.au..

Starship Hospital, Auckland, New Zealand. NigelW@adhb.govt.nz.. University of Auckland, Auckland, New Zealand. NigelW@adhb.govt.nz..

Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia. Susan.Donath@mcri.edu.au.. Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia. Susan.Donath@mcri.edu.au..

Centre for International Child Health, University of Melbourne, Parkville, Victoria, Australia. Andrew.Steer@rch.org.au.. Group A Streptococcal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia. Andrew.Steer@rch.org.au.. Royal Children's Hospital, Parkville, Victoria, Australia. Andrew.Steer@rch.org.au..

BMC cardiovascular disorders 2016-02-01; 16: 30

https://pubmed.ncbi.nlm.nih.gov/26830341/?otool=iaurydwlib

https://hdl.handle.net/10137/5391

Adolescent

Aortic Valve Insufficiency

Cardiology

Child

Child, Preschool

Echocardiography, Doppler, Color

Female

Fiji

Humans

Male

Mass Screening

Mitral Valve Insufficiency

Nurses

Observer Variation

Rheumatic Heart Disease

Schools

Sensitivity and Specificity

Education, Nursing

Screening for rheumatic heart disease: quality and agreement of focused cardiac ultrasound by briefly trained health workers.

Journal Article

Publication