Paediatric overdiagnosis modelled by coronary abnormality trends in Kawasaki disease

Archives of Disease in Childhood
Eric R CoonRajendu Srivastava

Abstract

Compare trends in coronary artery (CA) abnormality diagnoses to trends in adverse cardiac outcomes among American children with Kawasaki disease (KD) to assess the fit of detection of CA abnormalities to an established model of overdiagnosis. Multicenter retrospective cohort. 48 US children's hospitals in the Paediatric Health Information System database. Children <18 years receiving care for KD between 2000 and 2014. The main outcomes were rates of CA abnormality diagnoses and adverse cardiac outcomes, measured during a child's incident KD visit and longitudinally at all subsequent visits to the same hospital, through December 2016. CA abnormalities were considered severe if long-term anticoagulation other than aspirin was prescribed. Trends were tested using mixed effects logistic regression, adjusting for patient demographics. Among 17 809 children treated for KD, a CA abnormality was diagnosed in 1435 children (8%), including 1117 considered non-severe and 318 severe. The rate of non-severe CA abnormality diagnoses increased from 45 per 1000 patients with KD in 2000 to 81 per 1000 patients with KD in 2014, representing an adjusted 2.3-fold increased odds (95% CI 1.8 to 3.0) of diagnosis. There was no significant change in d...Continue Reading

References

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Oct 8, 2014·Pediatrics·Eric R CoonAlan R Schroeder
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Mar 6, 2015·BMJ : British Medical Journal·S M CarterA Barratt
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Jul 1, 2017·The Journal of Pediatrics·Etsuko TsudaYosuke Hayama

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Citations

Apr 13, 2018·Archives of Disease in Childhood·Martin Ward Platt
Sep 25, 2019·Hospital Pediatrics·Nathan M Money, John B Darby
Jan 5, 2020·Archives of Disease in Childhood. Education and Practice Edition·Alison KellyRobert Tulloh
Oct 31, 2021·Nature Reviews. Rheumatology·Chetan SharmaJagadeesh Bayry

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