- Design
- Systematic review and meta-analysis of randomised trials, GRADE-rated
- Population
- 8 trials, 4,106 children with Kawasaki disease
- Primary outcome
- Coronary artery abnormalities
- Effect
- Within 1 month RR 0.49 (0.17 to 1.42); after 1 month RR 0.81 (0.43 to 1.55)
This meta-analysis, published 14 September in the European Journal of Pediatrics, pooled eight randomised trials with 4,106 children with Kawasaki disease given corticosteroids alongside IVIG and aspirin.
There was no significant reduction in coronary artery abnormalities within one month (RR 0.49, 95% CI 0.17 to 1.42) or later (RR 0.81, 0.43 to 1.55), no clear difference in fever duration, and no difference in adverse events. Hospital stay was about one day shorter. Subgroups suggested benefit with prednisolone-based and longer regimens, but these were exploratory. Overall certainty was very low.
The wide confidence intervals include both meaningful benefit and none. Routine steroids for all children with Kawasaki disease are not supported; their use for high-risk or IVIG-resistant children rests on other evidence.
- Do not add corticosteroids routinely to IVIG and aspirin for every child with Kawasaki disease.
- Pooled trials showed no significant reduction in coronary abnormalities.
- Hospital stay was about one day shorter with corticosteroids.
- Decisions for high-risk or IVIG-resistant children should follow specific guidance, not this pooled result.
Why it matters
Tempers enthusiasm for adding steroids to every Kawasaki regimen.
Don't overread it
Very-low-certainty evidence; this does not rule out benefit in selected high-risk children.
The statistics, in plain English
An RR of 0.49 with a confidence interval of 0.17 to 1.42 is compatible with a large benefit or a small harm — the data are too uncertain to decide.
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