The quality of evidence is downgraded by inconsistency (variability in results).
A Cochrane review included 7 studies with a total of 922 children with Kawasaki disease. Two studies were conducted in North America and 5 in Japan. In 6 studies, all children were given intravenous immunoglobulin (IVIG) and aspirin and in 1 study IVIG, and the use of corticosteroids had to be the only difference in management between intervention and control arms. Corticosteroids reduced coronary artery abnormalities (OR 0.29, 95% CI 0.18 to 0.46, statistical heterogeneity I² = 55%; 7 studies, n=907), duration of fever (MD −1.65 days, 95% CI −3.31 to 0.00 days; statistical heterogeneity I² = 88%; 2 studies, n=210), time for laboratory parameters (erythrocyte sedimentation rate and CRP) to normalise (MD −2.80 days, 95% CI −4.38 to −1.22 days; 1 study, n=178) and length of hospital stay (MD −1.41 days, 95% CI −2.36 to −0.46 days; 1 study, n=39). No studies detailed outcomes beyond 24 weeks. No serious adverse events attributable to corticosteroid use were recorded (6 studies, n=737; no events). From the 7 studies (n=915) no deaths were recorded within the observed study period. None of the included studies included data on outcomes more than 1 year after study enrolment.
Subgroup analysis suggested that with respect to coronary abnormality, there was a benefit of steroids taken over a prolonged course versus the potential for no benefit if steroids were given as a one-off dose; the greatest benefit was in children with high-risk scores versus those with low-risk scores, although both displayed benefit; and the greatest benefit was in children in Japan versus those in North America, but the use of different regimens may have contributed to the different outcomes in Japanese and American studies, and the studies completed in North America were both considered part of the lower-risk group.
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