Performance of 2004 American Heart Association recommendations for treatment of Kawasaki disease.
Performance of 2004 American Heart Association recommendations for treatment of Kawasaki disease.
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DOI：
10.1542/peds.2009-0606
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发表时间：
2010-02
期刊：
影响因子：
8
通讯作者：
Newburger JW
中科院分区：
文献类型：
--
作者：
Yellen ES;Gauvreau K;Takahashi M;Burns JC;Shulman S;Baker AL;Innocentini N;Zambetti C;Pancheri JM;Ostrow A;Frazer JR;Sundel RP;Fulton DR;Newburger JW
2004年美国心脏协会（AHA）的声明包括临床病例定义和诊断和治疗疑似不完全性川崎病（KD）的算法。我们在一项多中心的KD合并冠状动脉瘤（CAA）的美国患者系列研究中探讨了这些建议的性能。我们回顾性分析了1981年至2006年美国4个中心的川崎病伴CAA患者的记录。根据z评分>3或日本厚生省标准定义CAA。我们的主要结局是在发病日≤21时就诊的患者在首次就诊时按照AHA指南接受静脉注射免疫球蛋白（IVIG）治疗的比例。在符合入选标准的195例患者中，137例（70%）符合病例定义，并在就诊时接受IVIG治疗。53例患者（27%）疑似不完全KD，符合算法应用条件;所有患者在就诊时均接受IVIG治疗。在其余5名患者中，3名患者因就诊时发热<5天而被排除在算法之外，2名患者因<2 clinical criteria at >年龄6个月而被排除在算法之外。这5例患者中有2例将进入算法，并在随访监测后接受IVIG治疗。总体而言，应用AHA算法将有≥190例患者（97%）接受IVIG治疗。应用2004年AHA的建议，与经典标准相比，提高了发生CAA的KD患者的IVIG治疗率。未来需要进行多中心前瞻性研究，以评估AHA算法在标准结果不完整的发热儿童中的性能特征，并进一步完善该算法。
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). 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 ≤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. 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 ≥190 patients (97%) for IVIG treatment. 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.