Kawasaki Disease - A Review of Treatment and Outcomes in an Irish Paediatric Cohort 2010-14
A M Flinn1, P J Gavin1, C J McMahon2,3
1Our Lady's Children's Hospital, Dublin, Ireland.
Insights
Diagnosing Kawasaki Disease (KD) is difficult, especially incomplete cases. Early IVIG treatment is crucial, and identifying high-risk children may improve outcomes and prevent coronary artery issues.
Area of Science:
- Pediatrics
- Cardiology
- Rheumatology
Background:
- Kawasaki Disease (KD) diagnosis lacks a specific test, complicating early identification.
- Incomplete KD cases present diagnostic challenges, potentially delaying treatment.
- Standard treatment with IVIG and aspirin may be insufficient for IVIG-resistant patients, increasing complication risk.
Purpose of the Study:
- To review treatment and coronary artery outcomes in pediatric patients with Kawasaki Disease.
- To evaluate the impact of incomplete diagnosis on treatment timing and outcomes.
- To identify factors associated with adverse outcomes in KD patients.
Main Methods:
- Retrospective review of medical records for 32 pediatric patients with KD.
- Analysis of treatment timelines, diagnostic criteria adherence, and echocardiogram findings.
- Assessment of coronary artery abnormalities at acute, 6-week, and long-term follow-up.
Main Results:
- 28% of patients (9/32) had incomplete KD diagnoses, receiving IVIG later than complete cases.
- 47% (15/32) showed acute phase echocardiogram abnormalities.
- 12.5% (4/32) had persistent coronary artery abnormalities post-treatment.
Conclusions:
- Kawasaki Disease diagnosis, particularly incomplete forms, presents challenges impacting timely treatment.
- A significant proportion of KD patients experience echocardiogram abnormalities, with some persisting.
- Identifying high-risk KD patients is essential for considering adjunctive therapies to mitigate adverse coronary artery outcomes.
Abstract:
Diagnosis of Kawasaki Disease (KD) can be challenging due to lack of a diagnostic test, and some children present with 'incomplete' KD when not all diagnostic criteria are met. Treatment with intravenous immunoglobulin (IVIG) and aspirin reduces the risk of coronary artery complications. There is sub-group of patients who are resistant to IVIG/aspirin therapy and are at increased risk of complications. Recent evidence suggests that additional treatment of this high-risk group with corticosteroids is beneficial in reducing this risk. We examine the treatment and coronary artery outcomes, by retrospective review of medical records, of a cohort of 32 paediatric patients with KD admitted to a single Irish tertiary centre from January 2010-December 2014. Twenty-eight percent of patients (9/32) had an incomplete diagnosis of KD; these patients received IVIG later compared to those with a complete KD diagnosis. 15/32 (47%) had abnormal echocardiogram findings in the acute phase, 8/32 (25%) had echocardiogram abnormalities at 6-week follow-up, and 4/32 (12.5%) had persisting abnormalities. This study highlights the potential for adverse outcome in KD, the difficulty in diagnosis in 'incomplete' cases, and the need to identify children at higher risk for adverse outcome where adjunctive therapies would be most beneficial.
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