Abstract
Misdiagnosis or missed diagnosis of Kawasaki disease (KD) is a problem in the United States (U.S.). To learn about current practice in diagnosing KD, we conducted a questionnaire survey of general pediatricians in San Diego County and U.S. members of the Pediatric Infectious Disease Society. Responses were obtained from 132/227 (58.1%) generalists and 345/651 (53.0%) subspecialists. Half of the general pediatricians and 90% of the pediatric subspecialists reported having made the diagnosis of KD in febrile patients (pts) who did not fulfill 4/5 clinical criteria. When asked about clinical criteria that trigger consideration of KD, generalists and subspecialists listed fever, rash, and conjunctival injection as the top three clinical signs. Cervical lymphadenopathy was considered an important criterion by the generalists (69/131, 52.7%) but not by the subspecialists (34/334, 10.2%). Despite the well-documented occurrence of KD throughout the pediatric age group, 71/124 (57.3%) generalists and 86/325 (26.5%) subspecialists did not consider the diagnosis in pts <6 mos of age. Similarly, 64/124 (51.6%) generalists and 81/324 (25.0%) did not consider the diagnosis of KD in pts >8 yrs. Laboratory studies reported to be most helpful in establishing the diagnosis of KD were (generalists;subspecialists): erythrocyte sedimentation rate (68.2%;74.2%), complete blood count (58.1%;40.0%), platelet count (51.9%;32.1%), urinalysis (46.5%;41.2%), and echocardiogram (45.0%;52.1%). Education about KD in the U.S. must emphasize that this disease can occur across the entire pediatric age range. Physicians have found the case definition to be overly specific and inadequately sensitive in establishing the diagnosis of KD. Formulation of a new case definition for improved sensitivity in early detection of KD cases may be warranted.
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Burns, J., Pannaraj, P., Turner, C. et al. Kawasaki Disease: Do We Need a New Case Definition?. Pediatr Res 53, 163 (2003). https://doi.org/10.1203/00006450-200301000-00059
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DOI: https://doi.org/10.1203/00006450-200301000-00059
