Performance of 2004 American Heart Association recommendations for treatment of Kawasaki disease.
OBJECTIVE
The 2004 American Heart Association (AHA) statement included a clinical case definition and an algorithm for diagnosing and treating suspected incomplete Kawasaki disease (KD). We explored the performance of these recommendations in a multicenter series of US patients with KD with coronary artery aneurysms (CAAs).


METHODS
We reviewed retrospectively records of patients with KD with CAAs at 4 US centers from 1981 to 2006. CAAs were defined on the basis of z scores of >3 or Japanese Ministry of Health and Welfare criteria. Our primary outcome was the proportion of patients presenting at illness day < or =21 who would have received intravenous immunoglobulin (IVIG) treatment by following the AHA guidelines at the time of their initial presentation to the clinical center.


RESULTS
Of 195 patients who met entry criteria, 137 (70%) met the case definition and would have received IVIG treatment at presentation. Fifty-three patients (27%) had suspected incomplete KD and were eligible for algorithm application; all would have received IVIG treatment at presentation. Of the remaining 5 patients, 3 were excluded from the algorithm because of fever for <5 days at presentation and 2 because of <2 clinical criteria at >6 months of age. Two of these 5 patients would have entered the algorithm and received IVIG treatment after follow-up monitoring. Overall, application of the AHA algorithm would have referred > or =190 patients (97%) for IVIG treatment.


CONCLUSIONS
Application of the 2004 AHA recommendations, compared with the classic criteria alone, improves the rate of IVIG treatment for patients with KD who develop CAAs. Future multicenter prospective studies are needed to assess the performance characteristics of the AHA algorithm in febrile children with incomplete criterion findings and to refine the algorithm further.
Yellen
Elizabeth S
ES
Children's Hospital Boston, Department of Cardiology, 300 Longwood Ave, Boston, MA 02115, USA. elizabeth.yellen@cardio.chboston.org
Gauvreau
Kimberlee
K
Takahashi
Masato
M
Burns
Jane C
JC
Shulman
Stanford
S
Baker
Annette L
AL
Innocentini
Nancy
N
Zambetti
Chiara
C
Pancheri
Joan M
JM
Ostrow
Adam
A
Frazer
Jeffrey R
JR
Sundel
Robert P
RP
Fulton
David R
DR
Newburger
Jane W
JW
D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000209:etiology; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D055815:Young Adult
D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors