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Rheumatic heart disease (RHD), caused by Streptococcus pyogenes infections, is driven by social determinants of health and disproportionately affects Aboriginal and Torres Strait Islanders in Australia (hereafter Indigenous Australians), causing [...]

Rheumatic Heart Disease (RHD) involves damage of heart valves following acute rheumatic fever (ARF), itself an autoimmune reaction to untreated/recurrent Strep A throat and/or skin infections often resulting in premature [...]

This article discusses the issue of discharge against medical advice (DAMA) among Aboriginal children in Australia. DAMA occurs when patients leave a healthcare facility before being formally discharged, which can lead to increased risks for readmission or poor health outcomes. The study found that DAMA rates were higher among Aboriginal patients, indicating potential issues with the responsiveness of hospitals to the needs of Aboriginal patients. Factors such as geographical context, maternal age, and urgency of the presentation were found to be associated with DAMA. The study suggests that improving access to culturally secure primary care and better resourcing of rural hospitals could help reduce DAMA rates among Aboriginal children. [Extracted from the article]

ObjectiveThis study aimed to investigate potential missed diagnoses of acute rheumatic fever and rheumatic heart disease during hospital-based care among persons subsequently identified with these conditions.MethodsThis retrospective cohort study used linked emergency department and inpatient administrative records from Queensland, Northern Territory, South Australia, and New South Wales during 2003-2018 (varying between jurisdictions by completeness of data) of all persons first identified with acute rheumatic fever or rheumatic heart disease while aged 8-24years. Using coded discharge diagnoses from the preceding 3years, we identified presentations (e.g. joint pains or heart murmur without specific identified cause) that potentially mimic and thereby represent a missed opportunity to detect acute rheumatic fever or rheumatic heart disease. Sociodemographic factors associated with experiencing ≥1 mimic diagnoses were investigated using multivariable logistic regression models.ResultsAmong 1855 persons, 65 (3.5%) (using narrow diagnostic inclusions) and 146 (7.9%) (with broad inclusions) experienced ≥1 mimic diagnosis. Joint disorders predominated. Mimics categorised as 'high-likelihood' (most specific) were more frequent among persons subsequently diagnosed as young adults (18-24years) than as children (8-12years) (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.34-4.47), and those from low-risk ethnic groups (including Australian-born non-Indigenous persons) compared with Aboriginal and Torres Strait Islander peoples (OR 2.44, 95% CI 1.02-5.85).ConclusionMissed opportunities to detect acute rheumatic fever and rheumatic heart disease continue to occur in Australian hospitals, and present disproportionately among persons from demographic groups considered to be at low risk, suggesting the need for enhanced clinical suspicion in these groups.