Our data do not provide support for the addition of a single pulsed dose of intravenous methylprednisolone to conventional intravenous immune globulin therapy for the routine primary treatment of children with Kawasaki disease. (ClinicalTrials.gov number, NCT00132080 [ClinicalTrials.gov].)
Objectives
To assess the performance of three risk scores from Japan that were developed to predict, in children with Kawasaki disease, resistance to intravenous immunoglobulin (IVIG) treatment.
Study design
We used data from a randomized trial of pulsed steroids for primary treatment of Kawasaki disease to assess operating characteristics of the three risk scores, and we examined whether steroid therapy lowers the risk of coronary artery abnormalities in patients prospectively classified as IVIG resistant.
Results
For comparability with published cohorts, we analyzed the data of 99 patients not treated with steroids (16% IVIG-retreated), and identified male sex, lower albumin and higher AST as independent risk factors for IVIG resistance. The Kobayashi score was similar in IVIG-resistant and responsive patients, yielding sensitivity=33% and specificity=87%. There was no interaction of high vs. low risk status by treatment received (steroid vs. placebo) using any of the three risk score algorithms.
Conclusion
Risk scoring systems from Japan have good specificity but low sensitivity for predicting IVIG resistance in a North American cohort. Primary steroid therapy did not improve coronary outcomes among patients prospectively classified as high risk for IVIG resistance.
Objective To evaluate the extent and determinants of missed prenatal detection of congenital heart disease (CHD) in a population-based setting. (OR, 4.3 (95% CI,), presence of extracardiac defects (OR, 2.7 (95% CI,) and ultrasound location i.e. high risk clinic vs clinic (OR, 2.1 (95% CI,
Methods
)). Defects that would be expected to have an abnormal outflow-tract view were missed more often (64%) than were those that would be expected to have an abnormal four-chamber view (42%).
ConclusionThe majority of CHD cases over the 10-year study period were missed prenatally and detection rates did not increase materially during that time. The failure to detect CHD prenatally was related to encounter characteristics, specifically involving screening ultrasound examinations, which may be targeted for improvement.
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