Effect of revision of Japanese diagnostic criterion for fever in Kawasaki disease on treatment and cardiovascular outcome.
BACKGROUND
The aim of this study was to investigate the effect of a revision of the fever criterion for initial intravenous immunoglobulin (IVIG) treatment, and cardiovascular sequelae, in the new Japanese diagnostic criteria for Kawasaki disease.


RESULTS
Patients who were reported in the 16th and 18th nationwide surveys in Japan were analyzed. New criteria group comprised patients who received the diagnosis of Kawasaki disease in the 18th nationwide survey (n=18,789). Old criteria group was comprised patients who received their diagnosis in the 16(th) nationwide survey (n=15,017). The difference between the new and old criteria for complete cases was only 1%. The proportion of patients who were treated with IVIG within 4 days of illness onset in the new criteria group was significantly lower than in the old criteria group (27.7% vs 30.7%). Multivariate logistic regression analysis identified criteria sex, age, recurrence, diagnosis, last day of initial IVIG and additional IVIG treatment as significant independent factors for cardiovascular sequelae.


CONCLUSIONS
The guideline revision improves diagnostic sensitivity somewhat, but reflects the clinical reality of the disease that approximately 30% of patients are treated with IVIG within 4 days of illness onset.
Muta
Hiromi
H
Department of Pediatrics, Kurume University School of Medicine, Kurume, Japan. qze05346@nifty.com
Ishii
Masahiro
M
Iemura
Motofumi
M
Suda
Kenji
K
Nakamura
Yosikazu
Y
Matsuishi
Toyojiro
T
D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D019992:Databases as Topic; D005260:Female; D005334:Fever / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D017408:Guidelines as Topic; D006306:Health Surveys; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors