Sources of Errors in Diagnosis of Acute Rheumatic Fever in Children

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Abstract
The history and clinical and laboratory findings in 455 patients referred with a possible diagnosis of rheumatic fever but found to have no rheumatic or related disease were studied with reference to the Jones criteria (modified) for the diagnosis of rheumatic fever. The interpretation of the data by the referring physician was compared with the interpretation arrived at by the hospital staff after a thorough evaluation of the patient. Common sources of error were (1) an innocent murmur or the murmur of acyanotic congenital heart disease interpreted as the murmur of rheumatic heart disease, (2) arthralgia interpreted as arthritis, (3) abnormal movements interpreted as chorea, (4) low-grade, persistent fever interpreted as rheumatic fever, (5) clinical evidence of sore throat interpreted as β hemolytic streptococcal pharyngitis, and (6) a rise in antistreptolysin O titer interpreted as indicating presence of rheumatic fever.

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