title: Persistence of acute rheumatic fever in a tertiary children's hospital.
abstract: OBJECTIVE
  To identify and describe all children admitted with acute rheumatic fever (ARF) to a tertiary paediatric hospital in Sydney over a 9-year period and to describe their demographic and clinical characteristics, management and short-term outcomes. Delays in diagnosis, recurrence of ARF and use of secondary prophylaxis were also documented.
  
  
  METHODS
  Retrospective review of medical records for children aged < 15 years admitted to the Children's Hospital at Westmead, Sydney, with ARF (International Classification of Diseases (ICD)-10 classification I0.0-109.9) during 2000-2008. Only cases meeting the National Heart Foundation of Australia diagnostic criteria for ARF were included.
  
  
  RESULTS
  Twenty-six children met the National Heart Foundation of Australia criteria for ARF. The median age was 11.5 years (range 5.8-14.6) and 15 (58%) were male. Ten (38%) identified as Pacific Islander, and 5 (19%) as Aboriginal and Torres Strait Islander (ATSI). Most (n= 20, 77%) lived in suburban Sydney, and 69% were classified in the two most disadvantaged quintiles on the Index of Relative Socioeconomic Disadvantage and Advantage. Four (15%) had Sydenham's chorea, and 81% had carditis (mitral and/or aortic regurgitation). Six (23%) children had previous ARF. Antibiotic prophylaxis to prevent recurrent ARF was prescribed in all cases, but 50% received oral penicillin, rather than by intramuscular injection. Barriers to timely diagnosis were identified in 81%, including delayed presentation and delayed referral.
  
  
  CONCLUSIONS
  Most children presenting to the hospital with ARF lived in disadvantaged areas of Sydney. Pacific Islander and Aboriginal and Torres Strait Islander children were over-represented. Mitigation of RHD requires early identification of ARF and appropriate delivery of secondary prophylaxis.
authors.affiliation: The Australian Paediatric Surveillance Unit, The Children's Hospital at Westmead, Westmead, New South Wales, Australia. apsu@chw.edu.au
authors.forename: Michael T
authors.initials: MT
authors.lastname: Smith
authors.forename: David
authors.initials: D
authors.lastname: Lester-Smith
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Zurynski
authors.forename: Sara
authors.initials: S
authors.lastname: Noonan
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Carapetis
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Elliott
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008485:Medical Audit; D009517:New South Wales / Q000453:epidemiology; D012189:Retrospective Studies; D012213:Rheumatic Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D000095283:Australian Aboriginal and Torres Strait Islander Peoples