Associated Symptoms in the Ten Days Before Diagnosis of Kawasaki Disease

Received 27 May 2008; received in revised form 4 September 2008; accepted 3 October 2008. published online 28 November 2008.

Objective

To describe common associated symptoms within the 10 days before diagnosis in subjects enrolled in the Pediatric Heart Network's trial of steroid therapy in Kawasaki disease (KD).

Study design

Patients with acute KD were enrolled between days 4 and 10 of illness at 8 centers between 2002 and 2004. We defined common associated symptoms as those occurring in ≥10% of patients. Principal clinical criteria for KD were not included in this analysis.

Results

Among 198 patients, irritability was reported in 98 (50%), vomiting in 88 (44%), decreased food/fluid intake in 73 (37%), cough in 55 (28%), diarrhea in 52 (26%), rhinorrhea in 37 (19%), weakness in 37 (19%), abdominal pain in 35 (18%), and joint pain (arthralgia or arthritis) in 29 (15%). One or more gastrointestinal symptom (vomiting, diarrhea, or abdominal pain) was present in 120 patients (61%) and 69 patients (35%) had ≥ 1 respiratory symptom (rhinorrhea or cough).

Conclusions

Nonspecific symptoms occur commonly in children with KD. To reduce delays in diagnosis, clinicians should be educated that such symptoms may comprise a significant component in the chief complaint.

Abbreviations: ESR, Erythrocyte sedimentation rate, IVIG, Intravenous immunoglobulin, IVMP, Intravenous methylprednisolone, KD, Kawasaki disease

a Children's Hospital Boston and Harvard Medical School, Boston, MA

b New England Research Institutes, Watertown, MA

c Primary Children's Medical Center, Salt Lake City, UT

d Medical University of South Carolina, Charleston, SC

e Columbia University Medical Center, New York, NY

f Duke University Medical Center, Durham, NC

g Children's Hospital of Los Angeles and University of Southern California, Los Angeles, CA

h University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada

i The Children's Hospital of Philadelphia, Philadelphia, PA

Reprint requests: Annette L. Baker, MSN, PNP, Department of Cardiology, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115

Supported by National Institutes of Health grants U01 HL068285 and RR 02172 (J.N., A.B., R.P.Sundel); U01 HL068270 (M.L., G.K.), U01 HL068292 (L.M., L.L.), U01 HL068281 (A.A.), U01 HL068290 (R.K.), U01 HL068269 (J.L.), U01 HL068288 (E.R.), and U01 HL068279 (V.V.) from the National Institutes of Health, and by the Ciarnanello Family Fund (A.B., J.N.). The authors declare no conflicts of interest, real or perceived.

Registered with clinicaltrials.gov (no.) NCT00132080.

⁎ A list of additional Pediatric Heart Network Investigators available at www.jpeds.com (Appendix 1).

PII: S0022-3476(08)00870-6

doi:10.1016/j.jpeds.2008.10.006

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