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Paediatric overdiagnosis modelled by coronary abnormality trends in Kawasaki disease
Eric R Coon1, Jacob Wilkes2, Susan L Bratton3
1Department of Pediatrics, Division of Hospital Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Insights
Diagnoses of non-severe coronary artery abnormalities in children with Kawasaki disease (KD) increased significantly, while severe abnormalities and adverse cardiac outcomes remained stable. This pattern suggests potential overdiagnosis of coronary artery issues in pediatric KD patients.
Area of Science:
- Pediatric Cardiology
- Kawasaki Disease Research
- Diagnostic Trends
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Coronary artery abnormalities (CAAs) are a significant complication of KD.
- Overdiagnosis of CAAs in KD has been a concern.
Purpose of the Study:
- To compare trends in CAA diagnoses with adverse cardiac outcomes in children with KD.
- To evaluate if increasing CAA detection fits an overdiagnosis model.
Main Methods:
- Retrospective cohort study of 17,809 children diagnosed with KD between 2000-2014 across 48 US hospitals.
- Analyzed rates of coronary artery abnormality diagnoses (severe and non-severe) and adverse cardiac outcomes.
- Used mixed effects logistic regression to assess trends over time, adjusting for demographics.
Main Results:
- The rate of non-severe CAA diagnoses increased from 4.5% in 2000 to 8.1% in 2014 (adjusted 2.3-fold increased odds).
- Diagnoses of severe CAAs remained stable.
- Adverse cardiac outcomes showed no significant trend over the study period (1.9% prevalence).
Conclusions:
- The rising incidence of non-severe CAA diagnoses, without a corresponding increase in adverse cardiac outcomes, is consistent with an overdiagnosis pattern in pediatric KD.
- This suggests a need to re-evaluate diagnostic criteria or practices for CAAs in children with KD.
Objective:
Compare trends in coronary artery (CA) abnormality diagnoses to trends in adverse cardiac outcomes among American children with Kawasaki disease (KD) to assess the fit of detection of CA abnormalities to an established model of overdiagnosis.
Design:
Multicenter retrospective cohort.
Setting:
48 US children's hospitals in the Paediatric Health Information System database.
Participants:
Children <18 years receiving care for KD between 2000 and 2014.
Main Outcome Measures:
The main outcomes were rates of CA abnormality diagnoses and adverse cardiac outcomes, measured during a child's incident KD visit and longitudinally at all subsequent visits to the same hospital, through December 2016. CA abnormalities were considered severe if long-term anticoagulation other than aspirin was prescribed. Trends were tested using mixed effects logistic regression, adjusting for patient demographics.
Results:
Among 17 809 children treated for KD, a CA abnormality was diagnosed in 1435 children (8%), including 1117 considered non-severe and 318 severe. The rate of non-severe CA abnormality diagnoses increased from 45 per 1000 patients with KD in 2000 to 81 per 1000 patients with KD in 2014, representing an adjusted 2.3-fold increased odds (95% CI 1.8 to 3.0) of diagnosis. There was no significant change in diagnoses of severe CA abnormalities. Adverse cardiac outcomes were stable over the study period at 19 per 1000 patients with KD (P=0.24 for trend).
Conclusions:
The rising rate of detection of non-severe CA abnormalities accompanied by an unchanging rate of adverse cardiac outcomes among American children with KD fits an overdiagnosis pattern.
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