Kawasaki Disease: More Patients Are Being Diagnosed Who Do Not Meet American Heart Association Criteria

Witt, Mark T.; Minich, L. LuAnn; Bohnsack, John F.; Young, Paul C.

doi:10.1542/peds.104.1.e10

Cited by 149 publications

(112 citation statements)

References 9 publications

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“…This observation has been noted in other studies. [20][21][22] The mean age of the EDG and DDG were not different. The proportion of children Ͻ1 year old in the EDG and DDG was not significantly different (Table 2); however, there were only 19 of 106 children Ͻ1 year old (13 in the EDG and 6 in the DDG).…”

Section: E430mentioning

confidence: 86%

Delayed Diagnosis of Kawasaki Syndrome: An Analysis of the Problem

2005

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ABSTRACT.Objective. Most pediatric providers in Colorado are familiar with Kawasaki syndrome (KS). However, in a recent outbreak, 30% of cases were diagnosed after illness day 10. We hypothesized that these children saw providers who were not familiar with KS, were given antibiotics for other diagnoses that delayed identification, had access-to-care issues, or presented atypically.Methods. A retrospective chart review of 106 consecutive KS cases seen at the Children's Hospital in Denver during 1994 -2000 was conducted.Results. Twenty-five of 106 children (23.6%) were diagnosed after day 10 of illness (delayed-diagnosis group [DDG]), and these 25 cases were compared with 81 cases diagnosed on or before day 10 (early-diagnosis group [EDG]). There were no differences between patients in the DDG and EDG in age, gender, number of visits, specialty of the primary care physician, time to the first medical visit, number of antibiotics received, coronary artery abnormalities, white blood cell count, or erythrocyte sedimentation rate. Patients in the DDG had significantly more days of fever, rash, red eyes, and oral changes. A platelet count of >450 000/mm 3 occurred more often in the DDG (56%) than the EDG (30%). After additional analysis, patients in the EDG had close clustering of symptom onset in the first few days of illness, but patients in the DDG had onset of symptoms scattered over 9 days. Patients in the DDG were 2.8 times more likely to have coronary artery aneurysms than patients in the EDG (DDG: 24%; EDG: 8.6%).Conclusions. Diagnosis after the 10th day of illness was not linked to type of medical provider, number of antibiotics received, or number of physician visits. Patients in the DDG exhibited the typical features of KS, but the onset of their symptoms was dispersed over time as opposed to the close clustering of symptoms in the EDG. Because coronary artery aneurysms occurred significantly more often in the patients in the DDG, more education is needed to teach health care providers to have a high index of suspicion for KS in young children presenting with fever/rash illnesses.

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Section: E430mentioning

confidence: 86%

Delayed Diagnosis of Kawasaki Syndrome: An Analysis of the Problem

2005

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“…Echocardiographic screening for coronary enlargement has shown that a substantial number of children with Kawasaki disease and coronary artery abnormalities are not identified by the classic case definition. [93][94][95] Thus, although the present case definition provides a specific tool for epidemiological surveillance, it may not be the optimal method for aiding clinicians in the recognition of children with a systemic vasculitis that requires prompt treatment. Given the potential seriousness of the complications, together with the efficacy and safety of early treatment, high sensitivity of the treatment criteria is more important than is high specificity.…”

Section: Criteria For Treatment Of Kawasaki Diseasementioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Circulation

1,604

818

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Background— Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ∼15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. Methods and Results— A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for ≥5 days and ≤4 classic criteria should undergo echocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-α antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. Conclusions— Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.

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“…Echocardiography has allowed to detect a considerable number of children with KD and CAD who do not meet the standard criteria. 10 Given that the presence of CAD is a very restrictive and specific criterion of incomplete KD, the AHA has developed an algorithm with clinical and analytical criteria for the evaluation and treatment of patients in whom incomplete KD is suspected, which we have used as a gold standard in this study. As in other studies, 11 we have found a longer diagnostic delay in incomplete forms, which, in our case, has been 24 hours (7 versus 6 days) and that in incomplete forms could be related to a higher risk of developing CAD.…”

Section: Discussionmentioning

confidence: 99%

Risk of coronary artery involvement in Kawasaki disease

2016

Arch Argent Pediat

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Kawasaki Disease: More Patients Are Being Diagnosed Who Do Not Meet American Heart Association Criteria

Abstract: Physicians are increasingly likely to diagnose KD in patients who do not meet complete AHA criteria. Despite the potential risks of overdiagnosis and overtreatment, this practice seems justified because the complete criteria are an insensitive indicator of having or developing CAA.

Cited by 149 publications

References 9 publications

Delayed Diagnosis of Kawasaki Syndrome: An Analysis of the Problem

Delayed Diagnosis of Kawasaki Syndrome: An Analysis of the Problem

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

Risk of coronary artery involvement in Kawasaki disease

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