Paul T von Hippel, David E Frisvold
Have States Reduced Obesity by Legislating More Physical Activity in Elementary School?
The Milbank quarterly
early detection diagnosis acute rheumatic fever rheumatic heart disease key preventing progression echocardiography important diagnostic role standard echocardiography might feasible highprevalence regions due high cost complexity time requirement handheld echocardiography might easytouse lowcost alternative performance screening diagnosing acute rheumatic fever rheumatic heart disease needs investigation systematic review metaanalysis searched embase medline lilacs conference proceedings citation indexscience feb 9 2024 studies screening diagnosis acute rheumatic fever rheumatic heart disease using handheld echocardiography index test standard echocardiography auscultation reference tests highprevalence areas included studies useable data diagnostic performance index test assessed reference test data test accuracy diagnosing rheumatic heart disease acute rheumatic fever carditis acute rheumatic fever primary outcomes extracted published articles calculated authors contacted necessary quality evidence appraised using grade quadas2 criteria summarised diagnostic accuracy statistics including sensitivity specificity estimated 95 cis using bivariate randomeffects model univariate randomeffects models analyses including three fewer studies area curve auc calculated summary receiver operating characteristic curves heterogeneity assessed visual inspection plots study registered prospero crd42022344081 4868 records identified 11 studies two additional reports comprising 15 578 unique participants pooled data showed handheld echocardiography high sensitivity 087 95 ci 076093 specificity 098 071100 overall high accuracy auc 094 084100 diagnosing rheumatic heart disease compared standard echocardiography two studies moderate certainty evidence better performance diagnosing definite compared borderline rheumatic heart disease high sensitivity 079 073084 specificity 085 080089 overall accuracy auc 090 085094 screening rheumatic heart disease observed pooling data handheld echocardiography versus standard echocardiography seven studies high certainty evidence studies low risk bias overall heterogeneity observed sensitivity specificity across studies possibly driven differences prevalence severity rheumatic heart disease level training expertise nonexpert operators handheld echocardiography high accuracy diagnostic performance compared standard echocardiography diagnosing screening rheumatic heart disease highprevalence areas world health organization chinese french italian persian portuguese spanish urdu translations abstract see supplementary materials section