title: Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association.
abstract: BACKGROUND
  Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries.
  
  
  RESULTS
  To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and long-term outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized asZscores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up.
  
  
  CONCLUSIONS
  These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances.
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: Anne H
authors.initials: AH
authors.lastname: Rowley
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.forename: Jane C
authors.initials: JC
authors.lastname: Burns
authors.forename: Anne F
authors.initials: AF
authors.lastname: Bolger
authors.forename: Michael
authors.initials: M
authors.lastname: Gewitz
authors.forename: Annette L
authors.initials: AL
authors.lastname: Baker
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Jackson
authors.forename: Masato
authors.initials: M
authors.lastname: Takahashi
authors.forename: Pinak B
authors.initials: PB
authors.lastname: Shah
authors.forename: Tohru
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Mei-Hwan
authors.initials: MH
authors.lastname: Wu
authors.forename: Tsutomu T
authors.initials: TT
authors.lastname: Saji
authors.forename: Elfriede
authors.initials: E
authors.lastname: Pahl
mesh_terms: D000465:Algorithms; D000572:American Heart Association; D000066491:Clinical Decision-Making; D032921:Consensus; D019091:Critical Pathways / Q000592:standards; D003661:Decision Support Techniques; D006801:Humans; D009080:Mucocutaneous Lymph Node Syndrome / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: AHA Scientific Statements; Kawasaki syndrome; aneurysm; arteritis; coronary vessels; immunoglobulins, intravenous; thrombosis; vasculitis