Key result
ESR cutoff of 56 optimally differentiates KDSS from TSS.
Why the study?
Due to the absence of specific diagnostic tests or pathognomonic clinical features, guidance was needed to help clinicians differentiate KD, KDSS, septic shock, and TSS earlier.
What clinical and laboratory features differentiate Kawasaki disease shock syndrome from septic shock, toxic shock syndrome, and Kawasaki disease in pediatric patients?
Case-Control (n=133)
No
What clinical and laboratory features differentiate Kawasaki disease shock syndrome from septic shock, toxic shock syndrome, and Kawasaki disease in pediatric patients?
Effect estimate: AUC 0.894 (95% CI 0.757-1.000)
p-value: p=0.003
Erythrocyte sedimentation rate, creatinine levels, and echocardiographic findings such as coronary aneurysms and left ventricular dysfunction can help differentiate Kawasaki disease shock syndrome from septic shock and toxic shock syndrome.
May aid earlier differentiation of KDSS from septic shock in children; leaves open prospective validation before guideline adoption.
BACKGROUND: Because of the absence of a specific diagnostic test and pathognomonic clinical features, physicians must rely on the presence of specific clinical criteria and laboratory data that support the diagnosis of KD. To help clinicians distinguish KD, KDSS, septic shock, and TSS earlier, we suggest differential diagnosis and treatment guideline. METHODS: Medical records of immunocompetent patients who were admitted to the pediatric department with a diagnosis of KDSS, septic shock or TSS (SS group) were retrospectively reviewed. In addition, KD patients were selected by seasonal matching to each case of KDSS patient by date of admission (± 2 weeks). RESULTS: There were 13 patients with KDSS, 35 patients with SS group, and 91 patients with KD. In comparison between KDSS and septic shock group, KDSS group had significantly higher rate of coronary aneurysm incidence, and higher left ventricle dysfunction rate. In comparison between KDSS and TSS, patients with KDSS had a significantly higher erythrocyte sedimentation rate (ESR) and significantly lower creatinine. Receiver operation characteristic curve revealed that the optimal ESR cut off value for determining the KDSS was 56.0 (sensitivity 75.0%, specificity of 100.0%) and the optimal creatinine cut off value for determining the TSS was 0.695 (sensitivity 76.9%, specificity 84.6%). CONCLUSIONS: Clinical symptoms, laboratory finding, echocardiography, and culture studies can be used to differentiate KD, KDSS, septic shock and TSS.
No takes yet. Share an insight, caveat, or question.
Park et al. (2021) conducted a case-control in Kawasaki disease shock syndrome, Kawasaki disease, Septic shock, Toxic shock syndrome (n=133). Kawasaki disease shock syndrome (KDSS) vs. Toxic shock syndrome (TSS) and Septic shock was evaluated on Optimal ESR cut-off value for determining KDSS vs TSS (AUC 0.894, 95% CI 0.757-1.000, p=0.003). An erythrocyte sedimentation rate cutoff of 56.0 optimally differentiated Kawasaki disease shock syndrome from toxic shock syndrome with 75.0% sensitivity and 100.0% specificity (AUC 0.894).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: