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A Study on Clinical Application of Harada's Scoring Method to Kawasaki Disease - Suggesting the revision of the criteria for IVGG treatment of KD in Korea -

Journal of the Korean Pediatric Society 1997;40(4):539-548.
Published online April 15, 1997.
A Study on Clinical Application of Harada's Scoring Method to Kawasaki Disease - Suggesting the revision of the criteria for IVGG treatment of KD in Korea -
Byoung Kil Han, Hyong Shin Lee, Hong Ryang Kil, Heon-Seok Han, Jae Ho Lee, Young Hun Chung
Department of Pediatrics, College of Medicine, Chungnam National University, Taejeon, Korea
가와사끼 질환 환아에서 Harada's Scoring Method의 임상적 적용에 관한 연구 - 국내 보험 인정 기준의 개선을 제안하며-
한병길, 이형신, 길홍량, 한헌석, 이재호, 정용헌
충남대학교 의과대학 소아과학교실
Abstract
Purpose
: We performed a study on clinical benefits of Harada's scoring method, problems of present criteria and requirement of the revision of that criteria for intrvenos γ-globulin(IVGG) treatment of Kawasaki disease(KD) in Korea.
Methods
: The patients of 104 cases who visited to Department of Pediatrics of Chungnam National University Hospital and diagnosed as KD were objective group. We classified the patients to high and low risk groups as two methods of Harada's scoring method and present criteria for IVGG treatment of KD in Korea, and analyzed the results after treatment by means of echocardiogram.
Results
: 1. Characteristics of the patients 1) Duration to diagnosis: Mean duration was 6.0±3.5days after onset of fever. 2) Age of onset and male to female ratio: the patients of 84.6% were the age of 4 years or less, and male to female ratio was 1.8 to 1. 2. Coronary aitery lesion(CAL) abnormalities according to items of Harada's scoring method and classification of risk groups 1) The age of less than 12 months and CRP of 3+ or more were significant predictive factors 2) Classification of risk groups was significantly predictive in CAL development. 3. Classification of total cases The patients reserved to administration for IVGG according to Harada's scoring method and present criteria for IVGG treatment of KD in Korea were 63.5% and 50% respectively. If so in present criteria for IVGG treatment of KD in Korea, 50% of the KD patients were excluded for that application. 4. Outcome after treatment according to selective IVGG use by two methods 1) Selective IVGG use by Harada's scoring method: There was no significant difference in development of CAL between low risk group and high risk group, resulting in 1 case(14.3%) of 7 cases and 5 cases(9.4%) of 53 cases respectively. 2) Selective IVGG use by present criteria for IVGG treatment of KD in Korea: There were more significant cases at low risk group than those at high risk group in development of CAL, resulting in 3 cases(42.9%) of 7 cases and 5 cases(12.2%) of 41 cases respectively. 3) Outcome after treatment in patients not administered IVGG as low risk groups according to two methods: There were more significant cases in low risk group at present criteria for IVGG treatment of KD in Korea than those at Harada's scoring method in the development of CAL, resulting in 3 cases(42.9%) of 7 cases and 1 case(14.3%) of 7 ases respectively. 4) Outcome after treatment in patients administered IVGG as high risk groups according to two methods: There was no significant difference between high risk groups at both methods in the CAL development, resulting in 5 cases(12.2%) of 41 cases at present criteria for IVGG treatment of KD in Korea and 5 cases(9.4%) of 53 cases at Harada's scoring method.
Conclusion
: Harada's scoring method had more benefits in clinical application, selection of risk group, and outcome after treatment, So we propose the revision of present criteria for IVGG treatment of KD in Korea, suggesting another method as indication for selective IVGG treatment.
Key Words: Kawasaki Disease, γ-globulin, Risk Factor


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