川崎病(KD)的医疗管理的关键方面尚未得到高证据水平的支持,从而为个人建议腾出空间。我们对现有的国际KD指南进行了结构化比较,以分析在实施有关诊断和治疗的循证KD建议方面的潜在差异。为了确定特定国家的准则,我们采取了多边方法,包括全面的PubMed文献,在线研究,并直接联系全国儿科协会。然后,我们进行了结构化指南分析,并评估了循证医学背景下的诊断和治疗差异。在这个结构化的指导方针分析中,我们确定了9个国家指南和1个欧洲指南.根据他们所有人的说法,KD的诊断仍然依赖于其临床表现,没有推荐可靠的生物标志物.一线治疗始终仅涉及静脉内免疫球蛋白(IVIG)治疗。乙酰水杨酸方面的建议,皮质类固醇,和额外的治疗选择差别很大。
结论:根据所有指南,KD在临床上被诊断为在定义不完全KD方面具有一些差异并且是对治疗的无应答者。一线治疗始终包括IVIG。其他治疗策略的建议更为异质。
背景:•KD的诊断依赖于临床表现,及时诊断带来挑战。•其他治疗选择,然后IVIG不支持高证据水平,为个人建议腾出空间。
背景:•不完全KD和对初始治疗无反应的定义在国家指南之间有一定程度的差异。•OnlyIVIGisconsistentlyproposedthroughoutallguidelines,进一步的治疗建议因国家建议而异.
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.
CONCLUSIONS: 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.
BACKGROUND: • 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.
BACKGROUND: • 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.