Children's Hospital Boston, Department of Cardiology, 300 Longwood Ave, Boston, MA 02115, USA.
Pediatrics. 2010 Feb;125(2):e234-41. doi: 10.1542/peds.2009-0606. Epub 2010 Jan 25.
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 < 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.
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.
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.
2004 年美国心脏协会（AHA）的声明包括疑似不完全川崎病（KD）的临床病例定义和诊断及治疗方案。我们通过在美国四个中心回顾性研究 KD 合并冠状动脉瘤（CAA）的多中心系列患者，探讨这些推荐意见的应用。
我们对 1981 年至 2006 年 4 个美国中心 KD 合并 CAA 患者的病历进行回顾性研究。CAA 的定义是 z 值>3 或日本厚生劳动省标准。我们的主要结局是根据 AHA 指南，在首次就诊临床中心时，比较 KD 患者就诊日≤21 天和>21 天的患者，按指南接受静脉注射免疫球蛋白（IVIG）治疗的比例。
195 例符合纳入标准的患者中，137 例（70%）符合病例定义，在就诊时将接受 IVIG 治疗。53 例（27%）为疑似不完全 KD，符合方案应用条件；所有患者就诊时将接受 IVIG 治疗。在其余 5 例患者中，3 例因就诊时发热<5 天，2 例因>6 个月龄时<2 个临床标准而被排除在方案之外。这 5 例患者中的 2 例经随访监测后将进入方案并接受 IVIG 治疗。总体而言，应用 AHA 方案将使>97%（190 例以上）KD 合并 CAA 的患者接受 IVIG 治疗。
与单纯应用经典标准相比，应用 2004 年 AHA 建议可提高 KD 患者发生 CAA 后接受 IVIG 治疗的比例。需要进行多中心前瞻性研究，以评估 AHA 方案在不完全标准 KD 发热儿童中的表现特征，并进一步完善方案。
