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Delayed Diagnosis by Physicians Contributes to the Development of Coronary Artery Aneurysms in Children With Kawasaki Syndrome

Wilder, Matthew S. MD*; Palinkas, Lawrence A. PhD*†; Kao, Annie S. MPH, PhD; Bastian, John F. MD§; Turner, Christena L. PhD*; Burns, Jane C. MD*

The Pediatric Infectious Disease Journal: March 2007 - Volume 26 - Issue 3 - p 256-260
doi: 10.1097/01.inf.0000256783.57041.66
Original Studies

Background: A diagnosis of Kawasaki syndrome is based on clinical criteria with nonspecific laboratory findings, and there is a substantial risk of coronary artery aneurysms if treatment with intravenous immunoglobulin is delayed. In this study, we examined the contributions of sociodemographic factors and parent and physician behavior to the development of coronary artery aneurysms in children with Kawasaki syndrome.

Methods: We performed a retrospective, case-control chart review of Kawasaki syndrome patients treated at our institution during an 11-year period (1991–2002). Of 324 patients, 21 patients had coronary artery aneurysms and were matched with 81 Kawasaki syndrome control patients without coronary artery aneurysms.

Results: Patients who developed coronary artery aneurysms were more likely to have had their diagnosis established after 10 days of fever as a result of a delay in physician recognition of Kawasaki syndrome. In addition, these patients were also more likely to have been hospitalized at an outside facility with an erroneous diagnosis, to have had a greater number of healthcare visits before diagnosis, to have sought medical care in Mexico, to lack medical insurance and to speak Spanish as a primary language. Independent predictors of delayed diagnosis included incomplete clinical signs of Kawasaki syndrome, seeking health care in Mexico, and being hospitalized at an outside facility with a different diagnosis.

Conclusions: Increased risk of coronary artery aneurysms is associated with a delay in diagnosis by physicians and not with a delay in seeking medical consultation by parents. Sociodemographic factors influence the likelihood that patients will have a delayed diagnosis.

From the *Departments of Pediatrics, Family and Preventive Medicine, and Sociology, University of California San Diego, La Jolla, CA; †School of Social Work, University of Southern California, Los Angeles, CA; ‡Department of Epidemiology, School of Public Health, San Diego State University, San Diego, CA; and §Department of Pediatrics, Rady Children’s Hospital, San Diego, CA.

Accepted for publication December 18, 2006.

Supported in part by Grant Nos. NIH HL69413 and K24 HL074864 from the National Institutes of Health, National Heart, Blood, and Lung Institute, Bethesda, MD (to J.C.B.).

Presented in part at the Pediatric Academic Societies’ Annual Meeting, Seattle, WA, May 2003.

Address for correspondence: Jane C. Burns, MD, Department of Pediatrics-0830, UCSD School of Medicine, 9500 Gilman Dr., La Jolla, CA 92093-0830. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.