Delayed diagnosis of Kawasaki disease: what are the risk factors?
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.
Minich
L LuAnn
LL
Primary Children's Medical Center, Salt Lake City, Utah, USA. l.luann.minich@ihc.com
Sleeper
Lynn A
LA
Atz
Andrew M
AM
McCrindle
Brian W
BW
Lu
Minmin
M
Colan
Steven D
SD
Printz
Beth F
BF
Klein
Gloria L
GL
Sundel
Robert P
RP
Takahashi
Masato
M
Li
Jennifer S
JS
Vetter
Victoria L
VL
Newburger
Jane W
JW
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis*; D015999:Multivariate Analysis; D012307:Risk Factors; D013997:Time Factors