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El Miedany Y, Salah S, Lotfy HM, Abu-Zaid MH, Mohamed SS, Maher SE, El Gaafary M, Abdulhady H, Farag Y, Eissa M, Radwan A, Medhat BM, El Mikkawy DME, Hassan WA, Mosa DM, El Deriny G, Mortada M, Osman NS, Fouad NA, Amer YA, Nasef SI, Abushady H, Galal S, El-Latif EA, Maria D, Shabana AH, Tabra SA. Egyptian evidence-based consensus on clinical practice recommendations for the management of Kawasaki disease. Egypt Rheumatol Rehabil 2023; 50:21. [PMCID: PMC10088797 DOI: 10.1186/s43166-023-00180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/10/2023] [Indexed: 09/02/2023] Open
Abstract
Background Kawasaki disease (KD) is an acute, self-limited febrile disease of unidentified cause that mostly affects children less than 5 years of age. This work aimed to provide an appropriate Egyptian evidence-based consensus on clinical practice recommendations for the management of Kawasaki disease. The main objective of this study, which employed the Delphi method, was to reach a consensus among experts on a treat-to-target management approach for KD. Results The expert panel was confined to an online survey (n =26), and all the expert completed the three rounds. At the conclusion of round 3, a total of 17 recommendation items were gathered, which were divided into two sections. The range of respondents (ranks 7–9) who agreed with the recommendations was 92.3 to 100%. All 17 clinical standards identified by the scientific committee were written in the same way. There have been algorithms proposed for managing various KD conditions. Conclusion The developed evidence-based consensus recommendations for the diagnosis and management of KD represent an up-to-date document that focuses on clinical management questions which are generally posed to health care professionals involved in the management of KD. This guideline was developed considering experience with and availability of treatment and diagnostic options in Egypt.
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Affiliation(s)
- Yasser El Miedany
- Canterbury Christ Church University, Kent, England
- King’s College London, London, England
| | - Samia Salah
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Hala M. Lotfy
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | | | | | | | - Maha El Gaafary
- Community Medicine and Public Health, Ain Shams University, Cairo, Egypt
| | - Hala Abdulhady
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | - Yomna Farag
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Mervat Eissa
- Rheumatology and Rehabilitation, Cairo University, Cairo, Egypt
| | - Ahmed Radwan
- Rheumatology and Rehabilitation, Sohag University, Sohag, Egypt
| | - Basma M. Medhat
- Rheumatology and Rehabilitation, Cairo University, Cairo, Egypt
| | | | | | - Doaa Mosad Mosa
- Rheumatology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Mohamed Mortada
- Rheumatology and Rehabilitation, Zagazig University, Zagazig, Egypt
| | | | | | | | | | - Hend Abushady
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Salwa Galal
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | | | - Dina Maria
- Cardiology, Tanta University, Tanta, Egypt
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Abu-Zaid MH, Salah S, Lotfy HM, El Gaafary M, Abdulhady H, Tabra SAA, Salah H, Farag Y, Eissa M, Maher SE, Radwan A, El-Shanawany AT, Medhat BM, El Mikkawy D, Mosad Mosa D, El Deriny G, Mortada M, Osman NS, Fouad NA, Elkaraly NE, Mohamed SS, Hassan WA, Amer YA, Nasef SI, El Miedany Y. Consensus evidence-based recommendations for treat-to-target management of immunoglobulin A vasculitis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211059610. [PMID: 34917176 PMCID: PMC8669874 DOI: 10.1177/1759720x211059610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/26/2021] [Indexed: 12/20/2022] Open
Abstract
IgA vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, is the most common cause of systemic vasculitis in childhood. Given its potential life-threatening systemic complications, early and accurate diagnosis as well as management of IgAV represent a major challenge for health care professionals. This study was carried out to attain an evidence-based expert consensus on a treat-to-target management approach for IgAV using Delphi technique. The preliminary scientific committee identified a total of 16 key clinical questions according to the patient, intervention, comparison, and outcomes (PICO) approach. An evidence-based, systematic, literature review was conducted to compile evidence for the IgAV management. The core leadership team identified researchers and clinicians with expertise in IgAV management in Egypt upon which experts were gathered from different governorates and health centers across Egypt. Delphi process was implemented (two rounds) to reach a consensus. An online questionnaire was sent to expert panel (n = 26) who participated in the two rounds. After completing round 2, a total of 20 recommendation items, categorized into two sections were obtained. Agreement with the recommendations (rank 7-9) ranged from 91.7-100%. Consensus was reached (i.e. ⩾75% of respondents strongly agreed or agreed) on the wording of all the 20 clinical standards identified by the scientific committee. Algorithms for the diagnosis and management have been suggested. This was an expert, consensus recommendations for the diagnosis and treatment of IgAV and IgA vasculitic nephritis, based on best available evidence and expert opinion. The guideline presented a strategy of care with a pathway to achieve a state of remission as early as possible. Plain Language Summary Given its potential life-threatening systemic complications, early and accurate diagnosis of immunoglobulin A vasculitis represents a major challenge for health care professionals. This work provided cornerstone principles for the management of the condition. Adopting PICO approach and implementing Delphi process a consensus was reached on evidence-based treat-to-target treatment recommendations. This will endorse enhancement and consistency of care of this cohort of patients in standard practice.
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Affiliation(s)
| | - Samia Salah
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Hala M Lotfy
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Maha El Gaafary
- Community Medicine and Public Health, Ain Shams University, Cairo, Egypt
| | - Hala Abdulhady
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | | | - Hala Salah
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | - Yomna Farag
- Pediatric Rheumatology, Cairo University, Cairo, Egypt
| | | | | | - Ahmed Radwan
- Rheumatology and Rehabilitation, Sohag University, Sohag, Egypt
| | | | - Basma M Medhat
- Rheumatology and Rehabilitation, Cairo University, Cairo, Egypt
| | - Dalia El Mikkawy
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | | | | | - Mohamed Mortada
- Rheumatology and Rehabilitation, Zagazig University, Zagazig, Egypt
| | | | | | | | - Sally S Mohamed
- Rheumatology and Rehabilitation, Cairo University, Cairo, Egypt
| | - Waleed A Hassan
- Rheumatology and Rehabilitation, Benha University, Benha, Egypt
| | - Youmna A Amer
- Rheumatology and Rehabilitation, Zagazig University, Zagazig, Egypt
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