Single center blind testing of a US multi-center validated diagnostic algorithm for Kawasaki disease in Taiwan

Abstract

BackgroundKawasaki disease (KD) is the leading cause of acquired heart disease in children. The major challenge in KD diagnosis is that it shares clinical signs with other childhood febrile control (FC) subjects. We sought to determine if our algorithmic approach applied to a Taiwan cohort.MethodsA single center (Chang Gung Memorial Hospital in Taiwan) cohort of patients suspected with acute KD were prospectively enrolled by local KD specialists for KD analysis. Our previously single-center developed computer-based two-step algorithm was further tested by a five-center validation in US. This first blinded multi-center trial validated our approach, with sufficient sensitivity and positive predictive value, to identify most patients with KD diagnosed at centers across the US. This study involved 418 KDs and 259 FCs from the Chang Gung Memorial Hospital in Taiwan.FindingsOur diagnostic algorithm retained sensitivity (379 of 418; 90.7%), specificity (223 of 259; 86.1%), PPV (379 of 409; 92.7%), and NPV (223 of 247; 90.3%) comparable to previous US 2016 single center and US 2020 fiver center results. Only 4.7% (15 of 418) of KD and 2.3% (6 of 259) of FC patients were identified as indeterminate. The algorithm identified 18 of 50 (36%) KD patients who presented 2 or 3 principal criteria. Of 418 KD patients, 157 were infants younger than one year and 89.2% (140 of 157) were classified correctly. Of the 44 patients with KD who had coronary artery abnormalities, our diagnostic algorithm correctly identified 43 (97.7%) including all patients with dilated coronary artery but one who found to resolve in 8 weeks.InterpretationThis work demonstrates the applicability of our algorithmic approach and diagnostic portability in Taiwan.

Retrospective analysis of clinical characteristics and related influencing factors of Kawasaki disease

“…KD, also known as mucocutaneous lymphoid syndrome, is an acute systemic vasculitis disease of infants under 5 years old. [ 1 , 3 ] The pathogenesis of the disease has not been clarified yet. It is difficult and controversial to diagnose and treat the disease because of its recurrence, diversity, atypical, degree of illness and many other characteristics.…”

“…[ 1 , 2 ] At present, the cause of the disease is unknown, and it is mostly detected in Asian children under 5 years old. [ 1 , 3 ] Coronary artery lesions (CAL) are common complications of KD, which can lead to ischemic heart disease, myocardial infarction, sudden death and other serious consequences. Timely diagnosis and treatment is the key to reduce CAL.…”

Bibliometric and visual analysis of Kawasaki disease in children from 2012 to 2022

“…Ho-Chang Kuo from Chang Gung Memorial Hospital, the author with the highest number of publications, has studied more on the diagnosis of KD and KD-related coronary artery lesions (CAL) ( 33 – 35 ). Among the cited authors, Jane W. Newburger from Harvard University was cited 770 times, the largest node in Figure 4A .…”

Diagnosis, Progress, and Treatment Update of Kawasaki Disease

“…In response, a subsequent algorithm involving 18 clinical and laboratory data points were devised. This new algorithm employed data-mining models to re-stratify patients with the aim of enhancing the identification of KD among children presenting with fever [ 32 ] which was further confirmed by a Taiwanese cohort with 418 KD and 259 FC from Kaohsiung Chang Gung Memorial Hospital [ 33 ].…”