RESIDENT Kyunghee university hospital SEOUL, Republic of Korea
Aim: This study aimed to evaluate the effectiveness of the American Heart Association (AHA) diagnostic algorithm for Kawasaki Disease (KD) in Korean patients.
Methods: We conducted a retrospective analysis based on a nationwide survey of KD in the Republic of Korea from 2015 to 2017. The AHA algorithm was utilized for data analysis of eligible patients.
Results: Our focus was on 3521 patients with incomplete KD who had sufficient data for analysis. Utilizing clinical symptoms at admission, blood tests, and echocardiographic examinations, we applied the AHA algorithm. Of these patients, 1916 aged over 6 months had fevers lasting more than 5 days with 2-3 major symptoms, while 52 patients under 6 months had fevers for over 7 days. Altogether, 1968 patients (55.9%) met the fever duration criteria of the algorithm. Among them, 1622 patients (82.4%) showed a CRP level of 3 or higher or an ESR of 40 or above. Of these, 500 patients met the laboratory criteria, 152 met the echocardiographic criteria, and 54 met both criteria. This resulted in only 598 out of the 3521 patients with incomplete KD (16.9%) being diagnosable as incomplete KD according to the AHA algorithm. In the group of 3521 patients, 412 were identified with acute phase coronary artery abnormalities (LAD or RCA z-score≥2.5), and 206 patients (50%) were diagnosable as having incomplete KD based on the AHA algorithm.
Conclusion: These results highlight the limitations of the current AHA diagnostic algorithm in diagnosing incomplete KD. It is evident that there is a need for a new diagnostic algorithm, one that incorporates adjustments in the fever duration and modifications in the laboratory criteria to better reflect the current clinical management of Kawasaki Disease.
