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Delayed diagnosis of Kawasaki disease: what are the risk factors?

Publication ,  Journal Article
Minich, LL; Sleeper, LA; Atz, AM; McCrindle, BW; Lu, M; Colan, SD; Printz, BF; Klein, GL; Sundel, RP; Takahashi, M; Li, JS; Vetter, VL ...
Published in: Pediatrics
December 2007

OBJECTIVE: Because late diagnosis of Kawasaki disease increases the risk for coronary artery abnormalities, we explored the prevalence of and possible risk factors for delayed diagnosis by using the database of the Pediatric Heart Network trial of corticosteroid treatment for Kawasaki disease. METHODS: We collected sociodemographic and clinical data at presentation for all patients who were treated for presumed Kawasaki disease at 8 centers (7 in the United States, 1 in Canada). Delayed diagnosis was evaluated by total number of illness days to diagnosis and by the percentage of patients who were treated after day 10 of illness. Independent predictors of delayed diagnosis were identified by using multivariate linear and logistic regression. RESULTS: Of the 589 patients who received intravenous immunoglobulin, 27 were treated before screening for the trial and excluded; 562 patients formed the cohort for analysis. Kawasaki disease was diagnosed at 7.9 +/- 3.9 days, 92 (16%) cases after day 10. Centers were similar with respect to patient age and gender. Centers differed in the patient percentage with incomplete Kawasaki disease; clinical criteria of cervical adenopathy, oral changes, and conjunctivitis; and distance of residence from the center. Independent predictors of greater number of illness days at diagnosis included center, age of <6 months, incomplete Kawasaki disease, and greater distance from the center. Independent predictors of diagnosis after day 10 were age of <6 months, incomplete Kawasaki disease, and greater distance). Socioeconomic variables had no association with delayed diagnosis. CONCLUSIONS: Even after adjustment for patient factors, illness duration at diagnosis varies by center. These findings underscore the need to maintain a high index of suspicion of Kawasaki disease in the infant who is younger than 6 months and has prolonged fever even with incomplete criteria. Outreach educational programs may be useful in promoting earlier recognition and treatment of Kawasaki disease.

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Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

December 2007

Volume

120

Issue

6

Start / End Page

e1434 / e1440

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Pediatrics
  • Multivariate Analysis
  • Mucocutaneous Lymph Node Syndrome
  • Male
  • Infant, Newborn
  • Infant
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Minich, L. L., Sleeper, L. A., Atz, A. M., McCrindle, B. W., Lu, M., Colan, S. D., … Pediatric Heart Network Investigators, . (2007). Delayed diagnosis of Kawasaki disease: what are the risk factors? Pediatrics, 120(6), e1434–e1440. https://doi.org/10.1542/peds.2007-0815
Minich, L LuAnn, Lynn A. Sleeper, Andrew M. Atz, Brian W. McCrindle, Minmin Lu, Steven D. Colan, Beth F. Printz, et al. “Delayed diagnosis of Kawasaki disease: what are the risk factors?Pediatrics 120, no. 6 (December 2007): e1434–40. https://doi.org/10.1542/peds.2007-0815.
Minich LL, Sleeper LA, Atz AM, McCrindle BW, Lu M, Colan SD, et al. Delayed diagnosis of Kawasaki disease: what are the risk factors? Pediatrics. 2007 Dec;120(6):e1434–40.
Minich, L. LuAnn, et al. “Delayed diagnosis of Kawasaki disease: what are the risk factors?Pediatrics, vol. 120, no. 6, Dec. 2007, pp. e1434–40. Pubmed, doi:10.1542/peds.2007-0815.
Minich LL, Sleeper LA, Atz AM, McCrindle BW, Lu M, Colan SD, Printz BF, Klein GL, Sundel RP, Takahashi M, Li JS, Vetter VL, Newburger JW, Pediatric Heart Network Investigators. Delayed diagnosis of Kawasaki disease: what are the risk factors? Pediatrics. 2007 Dec;120(6):e1434–e1440.

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

December 2007

Volume

120

Issue

6

Start / End Page

e1434 / e1440

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Pediatrics
  • Multivariate Analysis
  • Mucocutaneous Lymph Node Syndrome
  • Male
  • Infant, Newborn
  • Infant
  • Humans
  • Female