Delayed diagnosis of Kawasaki disease in Malaysia: Who is at risk and what is the outcome

Abstract

Background Data on the delayed diagnosis of (KD) is limited. This study aimed to determine the prevalence and trend of delayed diagnosis over time and identify the associated risk factors in Malaysia. Methods This retrospective, observational, population‐based study involved all children with KD registered in Johor Kawasaki Clinical Registry over 10 years (January 2010 and December 2019). The prevalence of delayed diagnosis and its trend over time was calculated. Multivariable binary logistic regression was used to identify the independent risk factors for delayed diagnosis. Results There were 556 cases of KD, with 28% having incomplete criteria, 11% atypical presentation, while 10% developed a coronary aneurysm. The overall prevalence of delayed diagnosis was 9.9% (95% confidence interval (CI): 7.6–12.7%). There was a statistically significant decrease in delayed diagnosis over time (P = 0.008), with the latest rate of 4.6%. The majority of delayed diagnoses were due to failure to diagnose the disease during the initial consultation. Independent risk factors for delayed diagnosis were children older than 1 year, diagnosis before 2015, atypical presentation, and incomplete KD, with adjusted odds ratios (ORs) of 2.7, 2.3, 4.3, and 3.6, respectively. Compared to early diagnosis of KD, delayed diagnosis was significantly associated with coronary aneurysms (27.3% vs. 8.2%, P < 0.001, OR 4.2, [95% CI: 2.1–8.3]). Conclusions One‐tenth of cases of KD were diagnosed late, but it has improved over time. Children > 1 year, presenting with atypical presentation, and incomplete criteria are associated with late diagnosis.

Exploring the diagnostic value of eosinophil-to-lymphocyte ratio to differentiate Kawasaki disease from other febrile diseases based on clinical prediction model

“…A recent study reported on the epidemiology and independent risk factors for delayed diagnosis of KD, which found that delayed diagnosis occurs in one in ten KD cases initially, but has gradually decreased to 4.6% over time. Children older than 1 year, with atypical clinical presentation and incomplete KD were associated with late diagnosis, while delayed diagnosis was strongly associated with the occurrence of CAL 25 . Pediatricians need accurate diagnosis of KD and timely treatment of KD in order to reduce the incidence of CAL.…”

Kawasaki Disease with Hepatobiliary Manifestations

“…Diagnosing KD in those who presented with atypical presentations of KD remains a challenge for physicians. Undeniably, one of the reasons for delayed diagnosis of KD is due to the atypical presentations [26]. Investigations, discussion with experts, and review of published guideline are mandatory to confirm or exclude the diagnosis of KD [27].…”