A Classification Tool for Differentiation of Kawasaki Disease from Other Febrile Illnesses

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• 作者：Shiying Hao ; PhD¹ ; Bo Jin ; MS¹ ; Zhou Tan ; PhD¹ ; Zhen Li ; BS¹ ; Jun Ji ; PhD¹ ; Guang Hu ; PhD¹ ; Yue Wang ; BS¹ ; Xiaohong Deng ; PhD¹ ; John T. Kanegaye ; MD² ; ³ ; Adriana H. Tremoulet ; MD ; MAS² ; ³ ; Jane C. Burns ; MD² ; ³ ; Harvey J. Cohen ; MD ; PhD⁴ ; Xuefeng B. Ling ; PhD¹ ; ^{bxling@stanford.edu" class="auth_mail" title="E-mail the corresponding author} ; on behalf of the Pediatric Emergency Medicine Kawasaki Disease Research Group^&lowast ; ; Lindsay T. Grubensky ; RN ; MSN ; CPNP-PC ; Jim R. Harley ; MD ; MPH ; Paul Ishimine ; MD ; Jamie Lien ; MD ; Simon J. Lucio ; MD ; Seema Shah ; MD ; Stacey Ulrich ; MD
• 关键词：incomplete KD ; KD diagnosis ; LDA ; random forest ; 2-step algorithm
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：176
• 期：Complete
• 页码：114-120.e8
• 全文大小：1869 K

文摘

To develop and validate a novel decision tree-based clinical algorithm to differentiate Kawasaki disease (KD) from other pediatric febrile illnesses that share common clinical characteristics.

Study design

Using clinical and laboratory data from 801 subjects with acute KD (533 for development, and 268 for validation) and 479 febrile control subjects (318 for development, and 161 for validation), we developed a stepwise KD diagnostic algorithm combining our previously developed linear discriminant analysis (LDA)–based model with a newly developed tree-based algorithm.

Results

The primary model (LDA) stratified the 1280 subjects into febrile controls (n = 276), indeterminate (n = 247), and KD (n = 757) subgroups. The subsequent model (decision trees) further classified the indeterminate group into febrile controls (n = 103) and KD (n = 58) subgroups, leaving only 29 of 801 KD (3.6%) and 57 of 479 febrile control (11.9%) subjects indeterminate. The 2-step algorithm had a sensitivity of 96.0% and a specificity of 78.5%, and correctly classified all subjects with KD who later developed coronary artery aneurysms.

Conclusion

The addition of a decision tree step increased sensitivity and specificity in the classification of subject with KD and febrile controls over our previously described LDA model. A multicenter trial is needed to prospectively determine its utility as a point of care diagnostic test for KD.