Kawasaki disease: More patients are being diagnosed who do not meet American Heart Association criteria

Objective. To determine the frequency of Kawasaki disease (KD) diagnosis in patients who did and did not meet American Heart Association (AHA) diagnostic criteria and to examine the clinical findings, the time to treatment, and the outcomes of the two groups. Design. Retrospective review of all patients with a discharge diagnosis of KD at a tertiary care children's hospital (1991-1997), Results. A total of 127 patients were identified. All received intravenous immune globulin (IVIG) and had complete echocardiographic studies. AHA criteria were met in 81 (63.8%). More patients who did not meet criteria (9 of 46, 20%) had coronary artery abnormalities (CAA), compared with those who had the complete clinical picture (6 of 81, 7%). The 15 patients with CAA received IVIG later (12.4 +/- 7.4 days) from onset of symptoms compared with those with no CAA (8.2 +/- 4.6). The time period was the same for patients with CAA who met the criteria, (11.8 +/- 5.8 days) as for patients who did not meet AHA criteria (12.5 +/- 8.6 days). Infants were more likely than were older children to develop CAA, to receive IVIG later, and to be diagnosed with an incomplete clinical picture. Conclusion. Physicians are increasingly likely to diagnose KD in patients who do not meet complete AHA criteria. Despite the potential risks of overdiagnosis and overtreatment, this practice seems justified because the complete criteria are;in insensitive indicator of having or developing CAA.