Published online November 19, 2007
PEDIATRICS Vol. 120 No. 6 December 2007, pp. e1434-e1440 (doi:10.1542/10.1542/peds.2007-0815)
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ARTICLE

Delayed Diagnosis of Kawasaki Disease: What Are the Risk Factors?

L. LuAnn Minich, MDa, Lynn A. Sleeper, ScDb, Andrew M. Atz, MDc, Brian W. McCrindle, MD, MPHd, Minmin Lu, MSb, Steven D. Colan, MDb, Beth F. Printz, MDe, Gloria L. Klein, MS, RDb, Robert P. Sundel, MDf, Masato Takahashi, MDg, Jennifer S. Li, MDh, Victoria L. Vetter, MDi, Jane W. Newburger, MD, MPHf for the Pediatric Heart Network Investigators

a Primary Children's Medical Center, Salt Lake City, Utah
b New England Research Institutes, Watertown, Massachusetts
c Medical University of South Carolina, Charleston, South Carolina
d University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
e Columbia University Medical Center, New York, New York
f Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
g Childrens Hospital Los Angeles and University of Southern California, California
h Duke University Medical Center, Durham, North Carolina
i Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

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.

Key Words: Kawasaki disease • delayed diagnosis • Pediatric Heart Network

Abbreviations: KD—Kawasaki disease • IVIg—intravenous immunoglobin • PHN—Pediatric Heart Network • OR—odds ratio

Accepted May 9, 2007.


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