key: cord-0863177-odq8a53t
authors: Harahsheh, Ashraf S.; Dahdah, Nagib; Newburger, Jane W.; Portman, Michael A.; Piram, Maryam; Tulloh, Robert; McCrindle, Brian W.; de Ferranti, Sarah D.; Cimaz, Rolando; Truong, Dongngan T.; Burns, Jane C.
title: Missed or Delayed Diagnosis of Kawasaki Disease During the 2019 Novel Coronavirus Disease (COVID-19) Pandemic
date: 2020-05-03
journal: J Pediatr
DOI: 10.1016/j.jpeds.2020.04.052
sha: 2f6da4fa0f2d67081328877827b70eb7e9c2ccb0
doc_id: 863177
cord_uid: odq8a53t

nan

have focused on COVID-19 management during the pandemic. Because of Bayesian thinking, other diseases may be underdiagnosed or undergo delayed treatment.

Because COVID-19 now leads as the probable diagnosis for first-line providers encountering febrile patients, the potential for missed or late diagnosis and treatment of Kawasaki disease in children is particularly concerning. 1 Prompt diagnosis of KD and treatment with intravenous immunoglobulin (IVIG) prevents coronary artery aneurysms (CAA). 2, 3 Without timely treatment CAAs could occur in up to 25% of children with Kawasaki disease. 3 We respectfully remind caregivers of the following principles for care of children with suspected or definite KD: 1) Keep a high suspicion for KD in all children with prolonged fever, but especially in those younger than 1 year; 2) Administer IVIG within 10 days, and ideally within 7 days, from onset of fever; 3) In the presence of ongoing systemic inflammation, children with Kawasaki disease presenting with greater than 10 days of fever and/or CAA may warrant IVIG treatment; 4) Continue to obtain recommended echocardiograms according to published guidelines 3 ; 5) Watch for late manifestations of KD, review the clinical history, and seek pediatric cardiology consultation 4, 5 ; 6) In the case of delayed diagnosis, refer to the American Heart Association management guidelines or contact an expert in Kawasaki disease 3 ; 7) Offer telemedicine services, remote echocardiogram, and direct to consumer visits that allow for nonverbal communication, when evaluating children with confirmed or suspected KD. [6] [7] [8] With this, we hope to avoid a future surge in prevalence of CAAs in patients due to missed or delayed diagnosis of KD.

Coronavirus Disease 2019 in China

COVID-19 and Kawasaki disease: novel virus and novel case. Hosp Pediatr

Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Periungual desquamation in patients with Kawasaki disease

Nail-bed lines in Kawasaki disease

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Direct-to Consumer Cardiology Telemedicine: A Single large

An Innovative Pilot Curriculum Training Pediatric Residents in Referral and Communication Skills on a Cardiology Rotation