Pediatric Rheumatology Online Journal → July 2003 → Vasculitides → Kawasaki Disease → Abstract #127

CORONARY ARTERY ABNORMALITIES IN CHILDREN WITH KAWASAKI DISEASE (KD): RELATIONSHIP TO DIAGNOSTIC CRITERIA

P. N. Malleson,¹ R. L. Ebbeson,¹ M. R. Riley,¹ D. G. Human,¹ J. Potts.¹

Pediatrics, University of British Columbia, Vancouver, BC, Canada

Objective: To investigate the relationship between number of diagnostic criteria and development of coronary artery abnormalities in children with a discharge diagnosis of KD from a tertiary care children's hospital.
Methods: A retrospective chart review of 176 patients with a discharge diagnosis of KD admitted to BC's Children's Hospital between January 1st 1992 and December 31st 2000. Patients were grouped into those fulfulling diagnostic criteria for KD (fever + 4/5 other criteria*), and those failing to fulfill criteria. The frequency of coronary artery (CA) abnormalities in each group was evaluated.
Results: Male:Female 1.8:1; Ethnicity: Caucasian 44.3%, Asian 35.8%; Mean age at diagnosis: 3.45 yrs (range 2mos-14yrs). Mean duration of hospitalization: 6.5 days (range 3-39 days). All patients received at least one dose of IVIG (2g/kg). 102 pts fulfilled diagnostic criteria for KD. Only 8.5% of patients met 5 days of fever and all other diagnostic criteria. The most common presentation was fever and 4 other criteria (36.9%).
Coronary artery abnormality Fulfilled criteria Failed to fulfill criteria P
(n=102) (n=74) (Fisher's)
CA dilatation or aneurysm (n=38) 19 (18.6%) 19 (25.7%) 0.27
CA aneurysm (n=13) 8 (7.8%) 5 (6.8%) 1.00
Giant CA aneurysm (n=6) 4 (3.9%) 2 (2.7%) 1.00
Conclusion: Coronary abnormalities occurred as frequently in children failing to fulfill criteria for KD as those who fulfilled these criteria.
Given the shortage of IVIG, and increasing restriction of its use to children fulfilling approved indications, the poor test characteristics of the present criteria for KD ia a potentially serious problem. There is a need for more accurate criteria for the diagnosis of KD.
* Diagnostic criteria: Fever 5 d, 1. Rash, 2. Non-purulent conjunctivitis, 3. Oral changes, 4. Extremity changes, 5. Cervical adenopathy 1.5cm. (Rauch, Hurwitz: CDC Case definition of KD. Ped Inf Dis J 1985;4:706-13)