LAUSR

### Clinical bottom lines Should we use steroids as primary therapy for Kawasaki disease? A young boy has been brought along to his cardiology appointment to monitor his coronary artery aneurysm, which developed as a complication of Kawasaki disease when he was 11 months old. You wonder, if he would have been as likely to develop a coronary abnormality, if he had been treated with steroids when he first presented with Kawasaki disease. In a child with acute severe Kawasaki disease, does the use of steroids as primary therapy, in addition to intravenous immunoglobulin, reduce the risk of developing a coronary abnormality? The MEDLINE library (1946–present), the Cochrane Library and the Embase database (1974–2018) were accessed. The search terms used were (Kawasaki OR mucocutaneous lymph node syndrome) AND (corticosteroid OR steroid OR Medical Subject Headings descriptor steroid) randomised controlled trials (RCTs), meta-analyses and systematic reviews were included to maintain a high quality of evidence. The references of the papers which were appropriate for abstract appraisal were also reviewed. Papers were excluded on the following basis: if the full text was not available and if the text was not in English or duplication. The papers were then excluded after the abstracts had been read and if they were not directly relevant to …