Acute phase of Kawasaki disease: a review of national guideline recommendations

• Published in: European journal of pediatrics Vol. 181; no. 7; pp. 2563 - 2573
• Main Authors: Scherler, Laura, Haas, Nikolaus A., Tengler, Anja, Pattathu, Joseph, Mandilaras, Guido, Jakob, André
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2022; Springer Nature B.V
• Subjects: Acetylsalicylic acid; Aspirin - therapeutic use; Biomarkers; Child; Corticosteroids; Diagnosis; Evidence-Based Medicine; Humans; Immunoglobulins; Immunoglobulins, Intravenous - therapeutic use; Intravenous administration; Kawasaki disease; Medicine; Medicine & Public Health; Mucocutaneous lymph node syndrome; Mucocutaneous Lymph Node Syndrome - drug therapy; Mucocutaneous Lymph Node Syndrome - therapy; Pediatrics; Review; Kawasaki disease; COVID-19 MISC-C; National guideline; Coronary artery aneurysm
• ISSN: 1432-1076; 0340-6199; 1432-1076
• DOI: 10.1007/s00431-022-04458-z

Key aspects of the medical management of Kawasaki disease (KD) are not yet supported by a high evidence level, thus making room for individual recommendations. We performed a structured comparison of existing international KD guidelines to analyze potential differences in the implementation of evidence-based KD recommendations regarding diagnosis and therapy. To identify country-specific guidelines, we took a multilateral approach including a comprehensive PubMed literature, online research, and directly contacting national pediatric associations. We then ran a structured guidelines’ analysis and evaluated the diagnostic and therapeutic differences in the context of evidence-based medicine. In this structured guideline analysis, we identified nine national and one European guidelines. According to them all, the diagnosis of KD still relies on its clinical presentation with no reliable biomarker recommended. First-line treatment consistently involves only intravenous immunoglobulin (IVIG) therapy. Recommendations in terms of acetylsalicylic acid, corticosteroids, and additional therapeutic options vary considerably.
Conclusion
: According to all guidelines, KD is diagnosed clinically with some variance in defining incomplete KD and being a non-responder to treatment. First-line treatment consistently includes IVIG. Recommendations for additional therapeutic strategies are more heterogeneous.
What is Known:
• The diagnosis of KD relies on the clinical presentation, entailing challenges in timely diagnosis.
• Other treatment options then IVIG are not supported by a high evidence level, making room for individual recommendations.
What is New:
• Definition of incomplete KD and being non-responsive to an initial treatment vary to some extent between the national guidelines.
• Only IVIG is consistently proposed throughout all guidelines, further therapeutic recommendations vary between the national recommendations.