Delayed Diagnosis of Kawasaki Disease: What Are the Risk Factors?

Minich, L. LuAnn; Sleeper, Lynn A.; Atz, Andrew M.; McCrindle, Brian W.; Lü, Minmin; Colan, Steven D.; Printz, Beth F.; Klein, Gloria L.; Sundel, Robert P.; Takahashi, Masato; Li, Jennifer S.; Vetter, Victoria L.; Newburger, Jane W.

doi:10.1542/peds.2007-0815

Cited by 128 publications

(102 citation statements)

References 20 publications

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“…Patients with incomplete KD, particularly those <6 months of age and those lacking eye or oral mucosal changes, may experience significant delays in diagnosis. 92 Studies evaluating the incomplete KD diagnostic algorithm first proposed in the 2004 guidelines 1 suggest its usefulness in identifying patients who require treatment and in preventing coronary artery aneurysms. 93,94 Incomplete KD occurs most commonly in infants, who are at substantial risk of developing coronary artery abnormalities and who may have prolonged fever as the sole clinical finding or have subtle or fleeting clinical signs in addition to fever.…”

Section: Incomplete (Atypical) Kdmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

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2,757

4,124

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BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

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Section: Incomplete (Atypical) Kdmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

Self Cite

2,757

4,124

View full text Add to dashboard Cite

show abstract

“…3,4 La forma de presentación incompleta de la EK se ha relacionado con un mayor retraso en el diagnóstico y en el inicio del tratamiento, que, a su vez, podrían ocasionar un mayor riesgo de AC. 5,6 El objetivo de este estudio es identificar los factores de riesgo asociados a la afectación coronaria en pacientes con EK completa e incompleta.…”

Section: Conflicto De Interesesunclassified

Riesgo de afectación coronaria en la enfermedad de Kawasaki

2016

Arch Argent Pediat

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“…3,4 Incomplete KD has been related to a greater delay in diagnosis and treatment onset, which, in turn, could result in a higher CAD risk. 5,6 Our objective is to identify risk factors associated with coronary artery disease in patients with complete and incomplete KD.…”

Section: Introductionmentioning

confidence: 99%

Risk of coronary artery involvement in Kawasaki disease

2016

Arch Argent Pediat

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Delayed Diagnosis of Kawasaki Disease: What Are the Risk Factors?

Cited by 128 publications

References 20 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Riesgo de afectación coronaria en la enfermedad de Kawasaki

Risk of coronary artery involvement in Kawasaki disease

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