RHEUMATIC FEVER: THE PROBLEM OF DIAGNOSIS BASED ON INSUFFICIENT EVIDENCE

Abstract

In 100 patients referred for consultation with a history of rheumatic fever and/or rheumatic heart disease, only 65 had a history of signs and symptoms sufficient to satisfy the modified Jones' criteria, used for guidance in the diagnosis of rheumatic fever. Moreover in patients without evidence of rheumatic heart disease referred because of a supposed history of rheumatic fever, the diagnosis could not be justified in one of every four children in this study. Many of the important manifestations of rheumatic fever do not require technical knowledge but merely interested and intelligent observation. The parents were found to be the most available and often the best source of information concerning a description of the manifestations of a previous episode of rheumatic fever. It is evident that the modified Jones' criteria are not being sufficiently used by the referring physicians as a guide in making a diagnosis. Clinical over-diagnosis was frequently encountered. Furthermore, there was a marked tendency for subsequent treating physicians to accept, and to perpetuate, a false "history of rheumatic fever" without critical evaluation. Obviously, whenever possible, the history should be justified by eliciting in detail the signs and symptoms observed in the past. Historical data must be obtained and compared with acceptable criteria for diagnosis, for the intelligent management of the patient depends upon such evaluation.