Jakob André, Whelan Jane, Kordecki Matthaeus, Berner Reinhard, Stiller Brigitte, Arnold Raoul, von Kries Rudiger, Neumann Elena, Roubinis Nicholas, Robert Mirna, Grohmann Jochen, Höhn René, Hufnagel Markus
From the *Department of Congenital Heart Defects, Heart Center University of Freiburg, Freiburg, Germany; †Novartis Pharma BV, Amsterdam, The Netherlands; ‡Clinic and Polyclinic for Pediatrics and Adolescent Medicine, University Children's Hospital, Technische Universität Dresden, Dresden, Germany; §Department of Pediatric Cardiology, University Hospital Heidelberg, Heidelberg, Germany; ¶Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilian's University Munich, München, Germany; and ‖Section of Pediatric Infectious Diseases and Rheumatology, Center for Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany.
Pediatr Infect Dis J. 2016 Feb;35(2):129-34. doi: 10.1097/INF.0000000000000953.
National estimates of Kawasaki disease (KD) incidence often do not include incomplete cases (diagnosed based on only laboratory or echocardiographic criteria), and/or they rely on retrospective case reports and data registries where underreporting is known to be a problem.
We conducted a prospective nationwide KD surveillance study in children younger than 5 years through the hospital-based German Pediatric Surveillance Unit (ESPED). We accounted for underreporting through applying capture-recapture methodology in 2 federal states using hospital discharge records with KD International Statistical Classification of Diseases and Related Health Problems 10th revision code (ie, M30.3). KD diagnosis (complete and incomplete) was established according to the American Heart Association criteria, 2004.
Incidence of KD, corrected for underreporting, was 7.2 of 100,000 in children younger than 5 years in Germany. Underreporting to ESPED was estimated at 37%-44%. Overall, 315 validated KD cases were reported. Of the 64 (20%) incomplete cases, 58% (37/64) were detected through echocardiographic findings and 42% (27/64) through laboratory criteria alone. Incomplete cases were younger than complete cases (1.2 vs. 2.0 years, P = 0.0001) and had more coronary aneurysms (43% vs. 11%, P = 0.0001).
A substantial number of incomplete KD cases were diagnosed based on the laboratory and echocardiographic criteria only. This was particularly the case in relation to infants younger than 1 year-an age group known to have an increased risk of developing coronary aneurysms. In addition, we found a high rate of underreporting to national Pediatric Surveillance Units. We suggest that improved surveillance and development of better diagnostic tests remain a high priority.
全国范围内川崎病（KD）发病率的估计通常不包括不完全病例（仅根据实验室或超声心动图标准诊断），和/或这些估计依赖于回顾性病例报告和数据登记处，而众所周知，这些地方存在报告不足的问题。
我们通过以医院为基础的德国儿科监测单位（ESPED），对5岁以下儿童进行了一项全国性前瞻性KD监测研究。我们在2个联邦州应用捕获-再捕获方法，利用带有KD国际疾病分类和相关健康问题第10次修订代码（即M30.3）的医院出院记录，来解决报告不足的问题。KD诊断（完全和不完全）根据美国心脏协会2004年的标准确定。
德国5岁以下儿童经校正报告不足后的KD发病率为每10万人中有7.2例。据估计，向ESPED的报告不足率为37%-44%。总体而言，报告了315例经核实的KD病例。在64例（20%）不完全病例中，58%（37/64）通过超声心动图检查发现，42%（27/64）仅通过实验室标准发现。不完全病例比完全病例年龄小（1.2岁对2.0岁，P = 0.0001），且冠状动脉瘤更多（43%对11%，P = 0.0001）。
大量不完全KD病例仅根据实验室和超声心动图标准诊断。1岁以下婴儿尤其如此，这一年龄组已知发生冠状动脉瘤的风险增加。此外，我们发现向国家儿科监测单位的报告不足率很高。我们建议加强监测和开发更好的诊断测试仍然是当务之急。
