Kawasaki Disease: Likelihood Ratios

Introduction: Kawasaki disease is a difficult disease to diagnose. The diagnosis relies on a constellation of symptoms.

[The following is taken from review article by Burns and Glode cited below]

The diagnosis is confirmed by the presence of fever for at least 5 days and of four of the five criteria below, and by the lack of another known disease process to explain the illness.

Bilateral conjunctival injection

Changes of the mucous membranes of the upper respiratory tract: injected pharynx; injected, fissured lips; strawberry tongue

Polymorphous rash

Changes of the extremities: peripheral oedema, peripheral erythema, periungual desquamation

Cervical adenopathy

The following is a review article on Kawasaki disease that includes an extensive differential diagnosis for each of the important symptoms in the constellation of findings that define Kawasaki disease: Burns JC, Glodé MP. "Kawasaki syndrome." 1: Lancet. 2004 Aug 7-13;364(9433):533-44. PMID: 18387169

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Tags: Autoimmune Pediatrics Vasculitis Tag this Diagnosis.

Differential Diagnoses include: Acute Streptococcal Pharyngitis

The likelihood ratios of findings for Kawasaki Disease are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding	+LR	-LR	Comments, Study
Clinical Criteria	2	0.2	as above, fever for 5 days plus at least 4/5: Bilateral conjunctival injection Changes of the mucous membranes of the upper respiratory tract: injected pharynx; injected, fissured lips; strawberry tongue Polymorphous rash Changes of the extremities: peripheral oedema, peripheral erythema, periungual desquamation Cervical adenopathy Mimics (from the J Peds article) include measles and group A Strep Differential Diagnosis: Acute Streptococcal Pharyngitis Study: sens: Acta Paediatr 1994 Oct;83(10):1057-60. PMID 7841704 spec: J Pediatr 1991 May;118(5):680-6. PMID 2019921
Anemia and Elevated ESR	7.1	0.5	Hb < -2 S.D. for age, ESR > 50mm/hr Study: J Pediatr 1991 May;118(5):680-6. PMID 2019921
Elevated ESR	3.5	0.5	>60 mm/hr Study: J Pediatr 1991 May;118(5):680-6. PMID 2019921