title: Delayed diagnosis of Kawasaki disease: what are the risk factors?
abstract: 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.
authors.affiliation: Primary Children's Medical Center, Salt Lake City, Utah, USA. l.luann.minich@ihc.com
authors.forename: L LuAnn
authors.initials: LL
authors.lastname: Minich
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Sleeper
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Atz
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: Minmin
authors.initials: M
authors.lastname: Lu
authors.forename: Steven D
authors.initials: SD
authors.lastname: Colan
authors.forename: Beth F
authors.initials: BF
authors.lastname: Printz
authors.forename: Gloria L
authors.initials: GL
authors.lastname: Klein
authors.forename: Robert P
authors.initials: RP
authors.lastname: Sundel
authors.forename: Masato
authors.initials: M
authors.lastname: Takahashi
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Li
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Vetter
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
mesh_terms: 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