Recommendation ID

Which signs and symptoms (or combinations of signs and symptoms) predict a diagnosis of Kawasaki disease in children under 5 presenting with fever lasting 5 days or more?

Any explanatory notes
(if applicable)

Why the committee made the recommendations
Prompt diagnosis and treatment of Kawasaki disease can prevent long-term cardiac complications. The 2013 version of the NICE guideline recommended that Kawasaki disease should be considered when children had a fever lasting 5 days and 4 of the 5 principal features specified by the American Heart Association diagnostic criteria. However, the evidence from case-series suggested that often fewer than 4 features are present early in the course of the illness, and some children may have 'incomplete' Kawasaki disease, in which fewer than 4 features are present throughout the course of the illness. Because of this, clinicians should think about Kawasaki disease in all children who have a fever lasting 5 days or longer, even when no additional features are present, and should be aware of the principal features of Kawasaki disease that would increase the probability of a Kawasaki disease diagnosis.
Based on the experience of the committee, features of Kawasaki disease may appear and disappear through the course of the illness, so it is important to ask parents and carers about and document these features to reach the correct diagnosis.
The evidence also showed that some of the principal features of Kawasaki disease are less common in children under 1 year. This was consistent with the committee's experience that incomplete Kawasaki disease is more common in this age group, so they wanted clinicians to be aware of this when thinking about Kawasaki disease as a possible diagnosis.
There is no existing evidence on how accurate most signs or symptoms are at ruling in or out Kawasaki disease in a group of children with fever. The committee made a research recommendation for a diagnostic accuracy study in this area to allow more specific recommendations to be made when the guideline is updated.

How the recommendations might affect practice
The recommendations should prompt clinicians to think about Kawasaki disease with fewer clinical features, which may result in more children being referred for assessment in secondary care. However, prompt identification and treatment of children with Kawasaki disease will reduce the number of children with long-term cardiac complications, which will reduce long-term costs for the NHS.
Full details of the evidence and the committee's discussion are in evidence review A: Signs and symptoms predicting Kawasaki disease.

Source guidance details

Comes from guidance
Fever in under 5s: assessment and initial management
Date issued
November 2019

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 30/11/2019