title: Recognising Kawasaki disease in UK primary care: a descriptive study using the Clinical Practice Research Datalink.
abstract: BACKGROUND
  Kawasaki disease is a rare childhood illness that can present non-specifically, making it a diagnostic challenge. The clinical presentation of Kawasaki disease has not been previously described in primary care.
  
  
  OBJECTIVE
  To describe how children with an eventual diagnosis of Kawasaki disease initially present to primary care in the UK.
  
  
  METHODS
  The Clinical Practice Research Datalink was used to find cases coded as Kawasaki disease. Hospital Episode Statistics, hospital admissions, and hospital outpatient attendances were used to identify the children with a convincing diagnosis of Kawasaki disease.
  
  
  METHODS
  Questionnaires and a request for copies of relevant hospital summaries, discharge letters, and reports were sent to GPs of the 104 children with a diagnosis of Kawasaki disease between 2007 and 2011.
  
  
  RESULTS
  Most children presented with few clinical features typical of Kawasaki disease. Of those with just one feature, a fever or a polymorphous rash were the most common. By the time that most children were admitted to hospital they had a more recognisable syndrome, with three or more clinical features diagnostic of Kawasaki disease. Most GPs did not consider Kawasaki disease among their differential diagnoses, but some GPs did suspect that the child's illness was unusual.
  
  
  CONCLUSIONS
  The study highlighted the difficulty of early diagnosis, with most children having a non-specific presentation to primary care. GPs are encouraged to implement good safety netting, and to keep Kawasaki disease in mind when children present with fever and rashes.
authors: Department of Primary Health Care Sciences, University of Oxford, Oxford.
authors: Abigail
authors: A
authors: Moore
authors: Department of Primary Health Care Sciences, University of Oxford, Oxford.
authors: Anthony
authors: A
authors: Harnden
authors: Department of Primary Health Care Sciences, University of Oxford, Oxford.
authors: Richard
authors: R
authors: Mayon-White
mesh_terms: D035843:Biomedical Research; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D003937:Diagnosis, Differential; D005260:Female; D058005:General Practitioners / Q000193:education; D006801:Humans; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology
keywords: Kawasaki disease; children; diagnosis; fever; primary care; rashes; safety netting