Kawasaki disease diagnosis and complication rates in the United States and Japan

Abstract

Clear diagnostic criteria and definitions of coronary artery lesions (CALs) were established in Japan by the Japanese Ministry of Health Research Committee (Fifth Revised Edition, February 2002) and the Japanese Circulation Society (JCS), and in the United States by the American Heart Association (AHA) and American Academy of Pediatrics (AAP), in 2004. Definitions and criteria for Kawasaki disease diagnosis slightly differ between the AHA/AAP and Japanese guidelines. The diagnostic criteria for classical Kawasaki disease in AHA/AAP guidelines include fever persisting at least 5 days and at least four of five other criteria. The criteria in the Japanese guidelines include fever as a sixth, equally important criterion, and patients must meet five of six criteria for diagnosis, including fever that subsides within 5 days in response to therapy. It is difficult to compare CAL rates in these countries because the definitions of CALs are completely different in the respective guidelines. The Japanese JCS guidelines for CALs use the diameter of each segment of coronary arteries. However, in the AHA/APP guidelines aneurysms are classified using z-scores. Previously reported differences in CAL rates between the United States and Japan likely resulted from use of different definitions and nomenclature. Development of standard criteria for CALs in both countries would allow meaningful comparisons between countries and facilitate collaborative international clinical trials.