Abstract 13654: Diagnosis of Kawasaki Disease: Do We Follow the 2004 American Heart Association Recommendations?
Background - In 2004, the American Heart Association (AHA) and the American Academy of Pediatrics (AAP) published recommendations for the optimal evaluation and management of patients with Kawasaki Disease (KD).
Objective - To determine if 2004 AHA/AAP recommendations were followed for KD diagnosis and management.
Methods - A retrospective cohort of all patients with an echocardiogram (echo) for evaluation of acute KD from 1/2007 - 9/2010 at a large tertiary care KD referral center was performed. Patients were excluded if evaluation occurred after 15 days of fever. Diagnosis of KD was determined by treatment with IVIg. Compliance with the AHA recommendations for KD diagnosis, including days of fever, clinical stigmata, and laboratory findings, was determined by medical record review.
Results - There were 221 patients meeting inclusion/exclusion criteria with six excluded due to incomplete data. The median age at evaluation was 33 months. IVIg was given to 172 patients with complete KD (cKD, n = 102) or incomplete KD (iKD, n = 70); 43 patients did not receive IVIg. cKD diagnostic criteria were met in 91 (90%) patients diagnosed with cKD while 24 (34%) patients treated with IVIg for iKD met the AHA criteria after reviewing the clinical, laboratory and echo criteria. There were 56 patients treated with IVIg for KD who did not meet clinical, laboratory, or echo recommendations for the diagnosis of KD (cKD or iKD). Overall, 35 echos demonstrated coronary artery changes (12 with iKD and 23 with cKD), all in patients who met clinical criteria and were treated for KD. A total of 55 echos were performed in patients who did not meet clinical criteria including insufficient clinical or laboratory criteria for the diagnosis of KD(cKD or iKD).
Conclusions -The AHA recommendations for the diagnosis of cKD are effective and utilized by most clinicians. The diagnosis of iKD is made in many children who do not meet AHA diagnostic criteria. In this population, utilizing the 2004 AHA diagnostic criteria, particularly in iKD, led to appropriate treatment in all children with coronary artery changes. Based on adherence to the AHA criteria, iKD is over diagnosed and over treated. Further education regarding the recommended KD diagnostic algorithm is needed to avoid unnecessary testing/treatment.
- © 2011 by American Heart Association, Inc.