Comparison Of Diagnostic Value Of Different Diagnostic Criteria For Kawasaki Disease

Objective To compare the diagnostic value of the Self-Standard of of Kawasaki disease and other four diagnostic criteria(Japanese standard,American standard,International standard and Domestic standard).Methods 300 children of clinically suspected KD were collected in April 2013-March 2017.They were divided into "typical KD","incomplete KD",and "excluding KD" group according to the Japanese,American,Domestic,International and self-standard criteria of KD,which the results of the clinical manifestation,laboratory examination,cardiac ultrasound and the clinical follow-up of the above suspected KD patients were regarded as the gold diagnostic standard.The diagnostic values(sensitivity,specificity,accuracy,false positive rate,false negative rate,positive predictive value,negative predictive value)of the five diagnostic criteria of KD were analyzed.Results 300 children of clinically suspected KD are associated with fever,196cases(65.3%)accompanied by hand and foot changes,225 cases(75%)accompanied by Oral changes,242 cases(80.7%)accompanied by bulbar conjunctiva hyperemia,213cases(71%)accompanied by rashes,72 cases(24%)accompanied by Cervical lymph node enlargement,67 cases(22.3%)accompanied by BCG vaccination site erythema and42 cases(14%)accompanied by coronary artery dilatation.215 children were diagnosed with typical KD and 38 children with atypical KD and 47 cases with excluding KD according to the gold diagnostic standard.For 300 children of clinically suspected KD,the International standard have the highest specificity of 100%,but that provided the lowest sensitivity and accuracy of 54.9% and 62% respectively.Self-made standard have the slightly lower specificity of 91.5% than international standards,but that provided the significantly higher sensitivity and accuracy of 96.8% and 92.3% respectively.Domestic standard provided the secondly sensitivity and specificity of 87.7% and 85.1%respectively.The Youden index have statistical significance among the self–made standard and the domestic standard,the American standard,the Japanese standard,and theinternational standard(P < 0.05).All the typical KD diagnosed by the five diagnostic criteria are accurately diagnosed by the gold standard.For incomplete KD,the sensitivity of national standards is relatively low.The sensitivity of the self-designed standards,the domestic standards,the American standards,and the Japanese standards are 50%,36.8%,36.8%,and 34.2% respectively.The specificity of the self-made standard is up to 98.5%,followed by the American standard and the Japanese standard.The Youden index have statistical significance among the self–made standard and the domestic standard,the American standard,and the Japanese standard(P < 0.05).Conclusions Compared with the Japanese standard,the American standard,the domestic standard and the international standard,the self-made standard summarizes the main condition and the reference diagnosis condition provided by other standards.Combining the national conditions of our country,and according to the probability and clinical value of each diagnosis condition,the diagnostic conditions are divided into the necessary conditions,the main conditions,the secondary conditions.They are clearly defined,and the diagnosis conditions are arranged in combination,the diagnosis is divided into typical,atypical and excluded cases.Obviously,it improves the orderliness,simplicity and practicability of the diagnostic standard,and makes the diagnosis of KD more explicit and standardized.