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The Harada score in the US population of children with Kawasaki disease
Helen Tewelde1, Jeein Yoon2, Wendy Van Ittersum2
1Departments of Pediatrics.
Insights
The Harada score effectively identifies children at high risk for coronary artery aneurysms in Kawasaki disease (KD) cases. Incomplete KD presentations increase CAA risk and delay diagnosis, highlighting the score
Area of Science:
- Pediatrics
- Cardiology
- Rheumatology
Background:
- Kawasaki disease (KD) is a critical pediatric illness associated with coronary artery aneurysms (CAAs).
- Accurate risk stratification is essential for managing KD and preventing cardiac complications.
- The Harada score is a tool developed to predict CAA risk in KD patients.
Purpose of the Study:
- To describe and quantify Kawasaki disease (KD) presentations over a decade in a US children's hospital.
- To evaluate the efficacy of the Harada score in predicting coronary artery aneurysm (CAA) risk within a US population.
Main Methods:
- Retrospective chart review of children diagnosed with KD between 2001 and 2011.
- Collection of demographic and clinical data, including derivation of Harada scores.
- Analysis of Harada score performance in predicting CAA development.
Main Results:
- 105 children diagnosed with KD; 97 had follow-up data. 64% had complete KD criteria, 36% had incomplete presentations.
- 10 children developed CAAs; 5 post-treatment with IVIG. Incomplete presentations correlated with higher CAA risk (20% vs 5%) and delayed diagnosis.
- Harada score demonstrated 90% sensitivity and 98% negative predictive value for CAA risk. All post-IVIG CAAs were in the high-risk group.
Conclusions:
- The Harada score is effective in identifying high-risk US children for CAA development in Kawasaki disease.
- The score can categorize children who develop CAAs post-IVIG into a high-risk group.
- The Harada score is valuable for identifying high-risk children for further evaluation and monitoring, though not for initial therapy selection.
Objective:
To describe and quantify the presentations of Kawasaki disease (KD) in a children's hospital over 10 years to assess the Harada score in a US population.
Methods:
A retrospective chart review from 2001 to 2011 of children discharged from Cleveland Clinic with the diagnosis of KD. Demographic and clinical data were collected and Harada scores were derived to evaluate efficacy in predicting risk for coronary artery aneurysms (CAAs).
Results:
A total of 105 children met diagnostic criteria for KD, and 97 of 105 had long-term follow-up. Full criteria for KD were found in 67 of 105 (64%); 38 had incomplete presentations. CAA developed in 10 children, 5 during follow-up despite treatment with intravenous immunoglobulin (IVIG.) Children with incomplete presentations had a higher risk of developing CAA (20% vs 5%, P = .03) and a delayed diagnosis (median days from fever to diagnosis 8.0 vs 5.0 days, P < .001). Of children who developed CAA, 9 of 10 had a positive Harada score (sensitivity of 90%). All children who developed CAA after IVIG were in the high-risk group, but 1 child with an incomplete presentation who had a CAA at presentation was missed by the score. Overall, the negative predictive value was 98%.
Conclusions:
As in Japanese studies, a positive Harada score in a US population could be used to identify a high-risk population for CAA development. All children who developed CAA after treatment with IVIG would have been assigned to a high-risk category. Though not specific enough to select initial therapy, the score might be useful in identifying high-risk children for evaluation of new therapies and more frequent follow-up.
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