1174. Preventing Coronary Artery Abnormalities in Children with Kawasaki Disease: A Need for Earlier Diagnosis and Treatment
Session: Poster Abstract Session: Kawasaki Disease
Saturday, October 22, 2011
Room: Poster Hall B1
Background: The clinical diagnosis of Kawasaki Disease (KD) is challenging and many clinicians may not seriously consider the diagnosis until five days of fever have elapsed. In addition, some clinicians do not expect to see coronary artery abnormalities (CAAs) at admission and believe they have a timeframe of 10 days from onset of illness to initiate therapy.

Methods:  We reviewed all cases of KD admitted to Children’s Hospital Colorado from January 2007 through February 2011.  All KD patients were diagnosed by a pediatric infectious disease specialist and all cases were independently reviewed by the authors who concurred with the diagnosis.  A retrospective chart review was conducted to collect demographic, clinical, laboratory and echocardiogram (ECHO) data.  CAAs were defined as Z score > 2.5.  Statistical analysis was performed using SAS version 9.2.

Results: A total of 210 patients were identified.  Fifty-seven (27.1%) of the 210 children had CAAs seen on ECHO at diagnosis or within 10 weeks of follow-up.  Forty six of the 57 (81%) children with CAAs had CAAs noted on the initial ECHO, and 11 (19%) had a normal initial ECHO but later developed CAAs. Of the 46 children who had CAAs detected on their initial ECHO, 35 (76%) had their ECHO done prior to illness day 10.  

The median age of the 46 children with an initial abnormal ECHO was 26.5 months (11.9 – 58.7 IQR) and 35 (76%) were male.  Thirteen (28%) of the children were less than 12 months of age and 4 (9%) were 8 years old or older.  The median day of treatment was 7 days (IQR 5-8.5) and the median number of visits to a health care provider prior to the diagnosis of KD was 3 (IQR 2-3).   Only 25 (54%) were classified as complete KD, but 40 (87%) had the triad of conjunctivitis, rash, and mucous membrane involvement.  At admission, 44 of 46 (96%) children met 3 of the 5 clinical criteria for KD.  Thirteen (28%) had IVIG resistant disease.

Conclusion: The vast majority (76%) of CAAs in children with KD were identified in the initial EHCO, prior to the tenth day of illness.  Earlier diagnosis and treatment is needed to impact the incidence of CAAs in children with KD.  Earlier clinical suspicion and inclusion of ECHO in the initial work-up may lead to a more prompt diagnosis in some children.  New diagnostic tests to include or exclude KD are urgently needed.


Subject Category: P. Pediatric and perinatal infections

Mohammed Eladawy, MD, PhD1, Samuel Dominguez, MD, PhD1, Marsha Anderson, MD2 and Mary Glode, MD, FIDSA1, (1)Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, (2)Pediatrics, Department of Pediatrics, Children's Hospital Colorado and University of Colorado Health Science Center, Aurora, CO

Disclosures:

M. Eladawy, None

S. Dominguez, None

M. Anderson, None

M. Glode, None

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