A PREDICTIVE INSTRUMENT FOR CORONARY-ARTERY ANEURYSMS IN KAWASAKI-DISEASE

To construct a predictive instrument for developing coronary artery ab normalities in patients with acute Kawasaki disease treated with aspir in and intravenous gamma globulin within the first 10 days of illness, data available from a multicenter database of patients with acute Kaw asaki disease were analyzed. A development data set (n = 212) was used to construct a sequential risk classification instrument based on eas ily measured baseline laboratory test results and temperature. The ins trument was then validated in 3 test data sets (n = 192, 264, and 92, respectively). Risk factors used in the sequential classification inst rument included baseline neutrophil and band counts, hemoglobin concen tration, platelet count, and temperature on the day after infusion of intravenous gamma globulin, In the development data set, the instrumen t classified 123 of 212 patients (58%) as low risk; none developed cor onary artery abnormalities. Among 89 patients classified as high risk, 3 of 36 female (8.3%) and 9 of 53 male patients (17.0%) developed cor onary artery abnormalities. The instrument performed similarly in the 3 test data sets; no patient in any data set classified as low risk de veloped coronary artery abnormalities. This simple instrument allows t he clinician to identify within 1 day of treatment low-risk children i n whom extensive and frequent cardiac testing may be unnecessary, as w ell as high-risk children who require closer monitoring and may be can didates for additional therapies. (C) 1998 by Excerpta Medica, Inc.