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Kawasaki disease in the older child
T Momenah1, S Sanatani, J Potts
1Division of Cardiology, Department of Pediatrics, British Columbia's Children's Hospital and the University of British Columbia, Vancouver, BC, Canada.
Insights
Kawasaki disease affects older children more than previously thought, leading to higher rates of coronary artery abnormalities. Delayed diagnosis in older children and infants may increase cardiac complications.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Infectious Diseases
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Typical presentation occurs in children younger than 5 years.
- Limited data exists on KD in older children.
Purpose of the Study:
- Determine KD prevalence in older children.
- Compare clinical presentation, diagnosis time, and outcomes in older vs. younger KD patients.
Main Methods:
- Retrospective analysis of 133 patients with KD over 12 years.
- Patients categorized into infants (1-8 years) and older children (≥9 years).
- Comparison of clinical findings, diagnosis delays, and cardiac outcomes.
Main Results:
- 7.5% of KD patients were ≥9 years old.
- Older children showed higher rates of abnormal cardiovascular exams (50%) and coronary artery abnormalities (80%) compared to 1-8 year olds.
- Older children and infants had increased coronary artery abnormalities and left ventricular dysfunction.
Conclusions:
- Higher prevalence of KD in older children observed than previously reported.
- Older age and delayed diagnosis are risk factors for cardiac involvement in KD.
- Early diagnosis and treatment are crucial for preventing cardiac complications.
Objectives:
To determine the prevalence of Kawasaki disease in older children and to evaluate its clinical presentation, time to diagnosis, and outcome in comparison with younger patients with the disease.
Methodology:
A retrospective analysis of all patients discharged with a diagnosis of Kawasaki disease at a pediatric tertiary care hospital over a 12-year period.
Results:
A total of 133 patients were included in this study; 7.5% were 9 years of age or older at the time of illness. Patients were grouped by age: infants included children age 1 to 8 years of age and children 9 years of age or older. Older children had a higher frequency of abnormal cardiovascular physical examination (50%) versus children (6%) and infants (10%). The older age group and the infants had a higher prevalence of coronary artery abnormalities and poor left ventricular function than did the 1- to 8-year-olds. Eighty percent of the older children had coronary arteries that were either dilated or aneurysmal, and 30% demonstrated left ventricular dysfunction on initial echocardiography. The number of days to diagnosis after meeting the diagnostic criteria was 5.8 +/- 2.3 for infants, 5.2 +/- 1.5 for older children, and 1.9 +/- 0.3 for children. Older children had a complicated course of Kawasaki disease compared with younger patients.
Conclusion:
We found a higher prevalence of older children with Kawasaki disease at our center than has previously been reported. Older patients, as well as infants, had a higher rate of coronary artery abnormalities than did the children between 1 and 8 years of age. Older age at the time of illness or a delay in treatment may be important factors in determining cardiac involvement in Kawasaki disease.