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Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. 475 (doi:10.1542/peds.2008-1459)
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LETTER TO THE EDITOR

Guidelines for Echocardiography of Low-Risk Patients With Kawasaki Disease

Adam Lowry, MD
Barry Myones, MD
Joe Tran, MD
Yong Han, MD
Department of Pediatrics,
Baylor College of Medicine,
Houston, TX 77030

To the Editor.—

A recent institutional review regarding follow-up cardiac imaging for low-risk patients with Kawasaki disease demonstrated significant variability in the timing and frequency of echocardiography. There are many factors that may account for this variability in practice and compliance with published guidelines for long-term management of these patients. One of the potential factors we have identified, which may have local and national implications, is the discrepancy between the most recent clinical guidelines for diagnosis, treatment, and long-term management of Kawasaki disease1 and the current Red Book.2

The American Heart Association guidelines, first published in 19943 and updated in 2004,1 recommend echocardiography of low-risk or "uncomplicated" patients with Kawasaki disease "at the time of diagnosis, at 2 weeks, and at 6 to 8 weeks after onset of the disease."1 Although the Red Book references the 2004 American Heart Association guidelines, the authors recommend that "an echocardiogram should be obtained early in the acute phase of illness and 6 to 8 weeks after onset." This recommendation is inconsistent with current American Heart Association guidelines and may partially account for local or national variability regarding follow-up practices for children diagnosed with Kawasaki disease.

We believe that this is a significant discrepancy; thus, we would like to reiterate the 2004 recommendations of the American Heart Association's Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease that echocardiography should be performed for all uncomplicated, low-risk patients with Kawasaki disease at diagnosis and at 2 and 6 to 8 weeks after the onset of disease.

REFERENCES

1. Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association [published correction appears in Pediatrics. 2005;115(4):1118]. Pediatrics. 2004;114 (6):1708 –1733[Abstract/Free Full Text]

2. American Academy of Pediatrics. Kawasaki disease. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics. 2006:412–415

3. Dajani AS, Taubert KA, Takahashi M, et al. Guidelines for long-term management of patients with Kawasaki disease. Report from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 1994;89 (2):916 –922[Abstract/Free Full Text]

PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
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Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
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Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lowry, A.
Right arrow Articles by Han, Y.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lowry, A.
Right arrow Articles by Han, Y.
Related Collections
Right arrow Infectious Disease & Immunity
Right arrowRelated AAP Red Book topics:
Group A Streptococcal Infections
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