Diagnosis of Kawasaki Disease Presenting with Limited and Faint Principal Clinical Features

Round 1

Reviewer 1 Report

The manuscript "Diagnosis of Kawasaki disease presenting with limited and faint principal clinical features" emphasizes the need for clinical experience in the identification of Kawasaki signs that may be overlooked early in the course of illness. Prompt diagnosis is necessary for timely treatment.

1. Can a senior resident in pediatric training in Japan really be considered a "young trainee" and lack knowledge of faint Kawasaki features? For example, was there any difference in identification of signs between 2nd year and 6th year doctors?
2. Did the experienced doctors identify faint features at the same time that young trainees presumably missed them? What is the evidence that the faint features were, in fact, missed (as opposed to showing up later)?
3. Given the manuscript title and Methods, I expected more description and explanation of how experienced doctors identified faint signs. However, my impression from what is written is that it wasn't so much the identification of faint signs, but the familiarity with KD in general and the need for prompt treatment, that motivated the experienced doctors to initiate KD treatment for patients with a limited number of criteria. After all, even with faint signs identified, some children did not meet criteria for complete KD. 

Background: Sentence 2 - specify that KD is the leading cause of acquired heart disease in children.

Limitations: The following sentence needs to be revised for clarity: However, the limited and faint principal features in some KD patients which we presented must are valuable information for junior doctors in Japan and other countries.

Conclusions: The following sentence needs to be revised for clarity: For junior doctors, educational programs for diagnosing KD, particularly teaching how to recognize f-Features, especially oral changes, and evaluate faint abnormal coronary artery findings are necessary to complement clinical experience is necessary.

 

Author Response

See attached file.

Author Response File: Author Response.pdf

Reviewer 2 Report

I read the article entitled “Diagnosis of Kawasaki Disease Presenting with Limited and Faint Principal Clinical Features” The aim of the study is interesting but some parts should be revised.

1. Typos should be corrected.
2. Abstract: The aim of the study is not clear.
3. Introduction:
4. The following sentence should be re-written:

“The diagnosis of KD is based on the presence of five or six principal clinical features (fever, conjunctivitis, oral changes, cervical lymphadenopathy, rash, erythema, and change of the extremities).”

The fever is a mandatory criterion so changed as:

The diagnosis of KD is made in the presence of fever for at least 5 d together with at least 4 of the 5 following principal clinical features.

1. Please clarify the following sentence: “However, it is applied for children with fever ≥5 days or infants with fever ≥7 days.” It doesn't seem to mean incomplete KD criteria.
2. Methods:
3. Why do authors choose patients with KD given antibiotics as their initial treatments? Please clarify.
4. How could the clinicians decide the definite features and faint features depending on retrospective evaluation?
5. Please clarify what are the definite features and faint features?
6. Statistical analysis part should be rewritten.
7. Results:
8. What about the laboratory features? Did experienced doctors use the compatible laboratory findings while making diagnoses?
9. The following paragraph is not clear:

“Without considering their duration of fever, the usefulness of the iKD-algorithm was ………..The sensitivity of the iKD-algorithm was 23% and increased to 43% among 14 patients who met the criterion for the iKD-algorithm.”

Author Response

See atached file.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

The authors responded to all the queries. Thank you for their nice effort