{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:21:15Z","timestamp":1789147275686,"version":"build-2803163510"},"reference-count":21,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,4,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND:<\/jats:title>\n                  <jats:p>Rheumatic heart disease (RHD) remains a major public health concern in developing countries, and routine screening has the potential to improve outcomes. Standard portable echocardiography (STAND) is far more sensitive than auscultation for the detection of RHD but remains cost-prohibitive in resource-limited settings. Handheld echocardiography (HAND) is a lower-cost alternative. The purpose of this study was to assess the incremental value of HAND over auscultation to identify RHD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>RHD screening was completed for schoolchildren in Gulu, Uganda, by using STAND performed by experienced echocardiographers. Any child with mitral or aortic regurgitation or stenosis plus a randomly selected group of children with normal STAND findings underwent HAND and auscultation. STAND and HAND studies were interpreted by 6 experienced cardiologists using the 2012 World Heart Federation criteria. Sensitivity and specificity of HAND and auscultation for the detection of RHD and pathologic mitral or aortic regurgitation were calculated by using STAND as the gold standard.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Of 4773 children who underwent screening with STAND, a subgroup of 1317 children underwent HAND and auscultation. Auscultation had uniformly poor sensitivity for the detection of RHD or valve disease. Sensitivity was significantly improved by using HAND compared with auscultation for the detection of definite RHD (97.8% vs 22.2%), borderline or definite RHD (78.4% vs 16.4%), and pathologic aortic insufficiency (81.8% vs 13.6%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>Auscultation alone is a poor screening test for RHD. HAND significantly improves detection of RHD and may be a cost-effective screening strategy for RHD in resource-limited settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2014-2774","type":"journal-article","created":{"date-parts":[[2015,3,17]],"date-time":"2015-03-17T00:48:40Z","timestamp":1426553320000},"page":"e939-e944","source":"Crossref","is-referenced-by-count":57,"title":["Handheld Echocardiography Versus Auscultation for Detection of Rheumatic Heart Disease"],"prefix":"10.1542","volume":"135","author":[{"given":"Justin","family":"Godown","sequence":"first","affiliation":[{"name":"Division of Pediatric Cardiology, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy C.","family":"Lu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, C.S. Mott Children\u2019s Hospital, University of Michigan, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Beaton","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Children\u2019s National Medical Center, Washington, District of Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Sable","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Children\u2019s National Medical Center, Washington, District of Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Mirembe","sequence":"additional","affiliation":[{"name":"Joint Clinical Research Centre, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Sanya","sequence":"additional","affiliation":[{"name":"Gulu University, Gulu, Uganda; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Twalib","family":"Aliku","sequence":"additional","affiliation":[{"name":"Gulu University, Gulu, Uganda; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunkyung","family":"Yu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, C.S. Mott Children\u2019s Hospital, University of Michigan, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Lwabi","sequence":"additional","affiliation":[{"name":"Uganda Heart Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine L.","family":"Webb","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, C.S. Mott Children\u2019s Hospital, University of Michigan, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Ensing","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, C.S. Mott Children\u2019s Hospital, University of Michigan, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2015,4,1]]},"reference":[{"key":"2021120907075721300_B1"},{"issue":"25","key":"2021120907075721300_B2","doi-asserted-by":"crossref","first-page":"3127","DOI":"10.1161\/CIRCULATIONAHA.112.092312","article-title":"Echocardiography screening for rheumatic heart disease in Ugandan schoolchildren.","volume":"125","author":"Beaton","year":"2012","journal-title":"Circulation"},{"issue":"5","key":"2021120907075721300_B3","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1056\/NEJMp078039","article-title":"Rheumatic heart disease in developing countries.","volume":"357","author":"Carapetis","year":"2007","journal-title":"N Engl J Med"},{"issue":"11","key":"2021120907075721300_B4","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1038\/nrcardio.2009.162","article-title":"Prevention and treatment of rheumatic heart disease in the developing world.","volume":"6","author":"Steer","year":"2009","journal-title":"Nat Rev Cardiol"},{"issue":"19","key":"2021120907075721300_B5","doi-asserted-by":"crossref","first-page":"1912","DOI":"10.1161\/CIRCULATIONAHA.114.009406","article-title":"Echocardiographic screening for rheumatic heart disease.","volume":"129","author":"Tani","year":"2014","journal-title":"Circulation"},{"issue":"4","key":"2021120907075721300_B6","first-page":"164","article-title":"Controlling rheumatic heart disease in developing countries.","volume":"17","author":"Carapetis","year":"2006","journal-title":"Cardiovasc J S Afr"},{"issue":"8","key":"2021120907075721300_B7","doi-asserted-by":"crossref","first-page":"e43917","DOI":"10.1371\/journal.pone.0043917","article-title":"Socioeconomic and environmental risk factors among rheumatic heart disease patients in Uganda.","volume":"7","author":"Okello","year":"2012","journal-title":"PLoS ONE"},{"issue":"23","key":"2021120907075721300_B8","doi-asserted-by":"crossref","first-page":"3584","DOI":"10.1161\/CIRCULATIONAHA.105.539775","article-title":"Rheumatic and nonrheumatic valvular heart disease: epidemiology, management, and prevention in Africa.","volume":"112","author":"Essop","year":"2005","journal-title":"Circulation"},{"issue":"11","key":"2021120907075721300_B9","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/S1473-3099(05)70267-X","article-title":"The global burden of group A streptococcal diseases.","volume":"5","author":"Carapetis","year":"2005","journal-title":"Lancet Infect Dis"},{"issue":"9480","key":"2021120907075721300_B10","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/S0140-6736(05)66874-2","article-title":"Acute rheumatic fever.","volume":"366","author":"Carapetis","year":"2005","journal-title":"Lancet"},{"issue":"3","key":"2021120907075721300_B11","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s11886-012-0343-1","article-title":"Echocardiographic screening for subclinical rheumatic heart disease remains a research tool pending studies of impact on prognosis.","volume":"15","author":"Z\u00fchlke","year":"2013","journal-title":"Curr Cardiol Rep"},{"issue":"4","key":"2021120907075721300_B12","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1111\/j.1540-8175.2009.01055.x","article-title":"High prevalence of rheumatic heart disease detected by echocardiography in school children.","volume":"27","author":"Bhaya","year":"2010","journal-title":"Echocardiography"},{"issue":"2","key":"2021120907075721300_B13","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.ijcard.2014.03.004","article-title":"Echocardiographic screening in a resource poor setting: borderline rheumatic heart disease could be a normal variant.","volume":"173","author":"Colquhoun","year":"2014","journal-title":"Int J Cardiol"},{"issue":"5","key":"2021120907075721300_B14","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1056\/NEJMoa065085","article-title":"Prevalence of rheumatic heart disease detected by echocardiographic screening.","volume":"357","author":"Marijon","year":"2007","journal-title":"N Engl J Med"},{"issue":"5","key":"2021120907075721300_B15","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1038\/nrcardio.2012.7","article-title":"World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease\u2014an evidence-based guideline.","volume":"9","author":"Rem\u00e9nyi","year":"2012","journal-title":"Nat Rev Cardiol"},{"issue":"7","key":"2021120907075721300_B16","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1038\/ncpcardio1185","article-title":"Evaluation of a screening protocol using auscultation and portable echocardiography to detect asymptomatic rheumatic heart disease in Tongan schoolchildren.","volume":"5","author":"Carapetis","year":"2008","journal-title":"Nat Clin Pract Cardiovasc Med"},{"issue":"1","key":"2021120907075721300_B17","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.echo.2013.09.013","article-title":"The utility of handheld echocardiography for early diagnosis of rheumatic heart disease.","volume":"27","author":"Beaton","year":"2014","journal-title":"J Am Soc Echocardiogr"},{"issue":"8","key":"2021120907075721300_B18","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1016\/S0735-1097(01)01288-8","article-title":"Physician-performed point-of-care echocardiography using a laptop platform compared with physical examination in the cardiovascular patient.","volume":"37","author":"Spencer","year":"2001","journal-title":"J Am Coll Cardiol"},{"issue":"9","key":"2021120907075721300_B19","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/S0894-7317(03)00426-7","article-title":"Unsuspected clinically important findings detected with a small portable ultrasound device in patients admitted to a general medicine service.","volume":"16","author":"Fedson","year":"2003","journal-title":"J Am Soc Echocardiogr"},{"issue":"2","key":"2021120907075721300_B20","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.echo.2010.09.017","article-title":"Usefulness of a new miniaturized echocardiographic system in outpatient cardiology consultations as an extension of physical examination.","volume":"24","author":"Cardim","year":"2011","journal-title":"J Am Soc Echocardiogr"},{"issue":"7","key":"2021120907075721300_B21","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1007\/s00246-014-0925-3","article-title":"Latent rheumatic heart disease: outcomes 2 years after echocardiographic detection.","volume":"35","author":"Beaton","year":"2014","journal-title":"Pediatr Cardiol"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/135\/4\/e939\/1060808\/peds_2014-2774.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/135\/4\/e939\/1060808\/peds_2014-2774.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T01:33:50Z","timestamp":1639100030000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/135\/4\/e939\/33597\/Handheld-Echocardiography-Versus-Auscultation-for"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,4,1]]},"references-count":21,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2015,4,1]]},"published-print":{"date-parts":[[2015,4,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2014-2774","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,4,1]]}}}