title: The clinical manifestations and risk factors of a delayed diagnosis of Kawasaki disease.
abstract: BACKGROUND
  Kawasaki disease (KD) is an acute febrile vasculitis and may cause coronary artery abnormalities. Due to the higher incidence in Asian countries, most pediatricians in Taiwan are familiar with KD. However, there are still some patients being diagnosed 10 days after the onset of the illness and not receiving a highly effective therapy. In this study, we analyzed the risk factors and clinical manifestations of patients with a delayed diagnosis of KD.
  
  
  METHODS
  A retrospective review was made of the medical records of the patients diagnosed with KD at our institution between January 1996 and December 2005. The patients were divided into 2 groups: early-diagnosis group (EDG: diagnosis was made within 10 days after the onset of the fever) and delayed-diagnosis group (DDG: diagnosis was made 10 days after the onset of the fever).
  
  
  RESULTS
  Fourteen of a total of 78 children (17.9%) were grouped into the DDG group, and 64 into the EDG group. There were no statistical differences between the 2 groups in terms of age, gender, number of antibiotics used, day of the first medical visit, total days of skin rash, conjunctivitis, mucosa changes, lymphadenopathy or laboratory examinations except for the higher white blood cell count and serum immunoglobulin G level in the DDG group. The patients in the EDG group had a clustered onset of symptoms as compared to the DDG group with a dispersed and late onset of symptoms. There was a higher risk of coronary artery abnormalities in the DDG group than the EDG group (42.9% vs. 14.1%; p = 0.036), and in the patients with KD who were younger than 1 year (29.0% vs. 12.7%; p = 0.043).
  
  
  CONCLUSIONS
  Patients with delayed diagnosis of KD were associated with higher risk of developing coronary arterial lesions. It is necessary to develop a diagnostic test for KD and provide more education to health care providers for early recognition of KD.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Juan
authors.forename: Betau
authors.initials: B
authors.lastname: Hwang
authors.forename: Pi-Chang
authors.initials: PC
authors.lastname: Lee
authors.forename: Yu-Jan
authors.initials: YJ
authors.lastname: Lin
authors.forename: Jen-Chung
authors.initials: JC
authors.lastname: Chien
authors.forename: Hsin-Yuan
authors.initials: HY
authors.lastname: Lee
authors.forename: C C Laura
authors.initials: CC
authors.lastname: Meng
mesh_terms: D002675:Child, Preschool; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology*; D042241:Early Diagnosis; D004452:Echocardiography; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000175:diagnosis; D012307:Risk Factors