Survey of Harada Scoring of Occurrence of Coronary Aneurysm in Kawasaki Disease Compared to Current Criteria

Nam, Chang Kyu; Kim, Yong Wook; Kim, Ki Bok

Abstract

PURPOSE: Gamma-globulin is effective in preventing coronary aneurysm, the primary complication of Kawasaki disease(KD). However, in order to predict high-risk cases which absolutely require gamma-globulin, because of its high expenses, Harada score(HS) was introduced in Japan in 1990. We attempted to compare HS scoring with the health insurance criteria currently used in Korea.
METHODS
Retrospective studies were performed on 123 cases who did not receive gamma-globulin among 283 KD patients who had been treated in this hospital from 1990 to 1997. Chi-square analyses were used.
RESULTS
Of the 123 subjects, 91(74%) had HS scores higher than 4, and 32(26%) had HS less than 4, whereas 56(45.5%) belonged to the high-risk group and 67(54.5%) to the low-risk group according to the insurance criteria, with both methods differing significantly(P<0.001). Of 18 cases with the coronary complications only 2 cases had an HS<4, whereas 4 patients belonged to the low-risk group. Even though both methods did not differ significantly in discriminating risky cases, twice as many patients may have been denied adequate treatment if the insurance criteria had been applied. Of various factors, the age and albumin level were found relevant to the coronary complication.
CONCLUSION
No statistically significant difference was found between HS and the insurance criteria in predicting the incidence of coronary complications in 123 KD patients. But a less lenient criteria used in the current health insurance policy may result in more cases with coronary complications.