1. Complete & Incomplete Kawasaki Disease: Two sides of the same coin
Journal Club Presentation
Mekhala Ayya
ST3 Paediatrics

2. Reasons for choosing this topic??
Multiple recent cases
Having a Rheumatologist as an Educational Supervisor
Parents asking me instead of the Rheumatology team

3. Kawasaki Disease ( Complete)
Diagnosis based on fulfilment of set criteria
At least 4 out of 5 clinical signs:
(a)Bilateral conjunctival injection
(b)Cervical Lymphadenopathy
(c) Polymorphous rash
(d) Changes to oral mucosa or lips
(e) Changes in distal extremities

4. Kawasaki Disease (Complete)
Associated Laboratory features:
CRP ↑
ESR↑
Platelets ↑
WCC ↑
Albumin↓

5. Kawasaki Disease ( Incomplete)
Interchangeable term with Atypical
Variable definitions
Mainly describes children who have complications such as coronary aneurysms in the absence of “ full clinical spectrum”
May have lab/ image findings without clinical signs

6. Kawasaki Disease ( Incomplete)
Occurs at the extremes of age
< 1year of age
>5- 9 years of age
Laboratory findings:
Albumin ↓
Anaemia
ALT ↑
WCC ↑
Platelets ↑
Urine WBC ↑

7. Primary Outcomes Comparison of clinical findings Treatment response
Increased risk of cardiac complications for those with incomplete KD

8. Methods Conducted between January 1990 – April 2007, Toronto, Canada
All patients with diagnosed Kawasaki assessed
Retrospective
Didn’t need ethical approval as retrospective study
Excluded patients diagnosed with KD pre-transfer

9. Methods- Classification
Complete KD:
4 clinical signs
Fever for at least 5 days
Incomplete KD:
2 or 3 clinical signs
Fever
All patients received standardised treatment and follow up

10. Methods- Data Collected
Clinical features
Additional clinical findings
Patient demographics
Laboratory results
Z-scores for RCA/ LCA/ LAD Aneurysms

11. Results
Total 1374 KD cases
98 excluded due to insufficient clinical details
321 excluded as they were diagnosed pre-transfer
955 KD cases included
Complete KD – 738
Incomplete KD- 217 ( 53 with 2 symptoms & 164 with 3 symptoms)

12. Table 1 from Study

13. Table 2& 3

14. Table 4

15. Limitations of study Conducted over a prolonged period
Changes in the diagnostic criteria/ clinical features – incomplete KD mean that some patients may have been missed
Not including those diagnosed pre-transfer (? More Incomplete KD)

16. Conclusions - Incomplete
Cardiac outcomes are similar
Patients at extremes of age
Delay to diagnose – 1 day
Less likely to be treated < 10 days after onset of illness
Less likely to get IVIG but similar number of patients received Aspirin
Similar length of hospital stays
+ve correlation between Age ( < 1 yr) and maximum coronary z-score
Do we need a more clear diagnostic criteria for Incomplete KD ?

17. CASP Tool Did the study address a clearly focused issue? YES
Was the cohort recruited in an acceptable way? YES
Was the exposure accurately measured to minimise bias? YES
Was the outcome accurately measured to minimise bias? YES
Have the authors identified all important confounding factors? NO ( Not all KD patients in that period were included in the study ie. The transfer patients)
Have they taken into account confounding factors in design? YES
Was the follow up of subjects complete enough? YES
Was the follow up of subjects long enough? CAN’T TELL
Do I believe the results? YES
Can the results be applied locally? YES
Do the study results fit with other available evidence? YES

18. Thank you