Suspected Kawasaki Disease
Fever ≥5 days + clinical features
All Pathways
PediatricsManagement
Kawasaki Disease (AHA 2024)
Kawasaki Disease (AHA 2024): Suspected Kawasaki Disease → Diagnostic Criteria → Echocardiogram → Risk Stratification (AHA 2024) → Standard Treatment.
Pathway Overview
9 steps
Algorithm Steps
9 total
01Start 02Action Diagnostic Criteria
Classic KD: Fever ≥5 days + ≥4 of 5 features
- PRINCIPAL FEATURES:
- 1. Bilateral non-purulent conjunctival injection
- 2. Oral mucous membrane changes (red lips, strawberry tongue)
- 3. Peripheral extremity changes (erythema, edema, desquamation)
- 4. Polymorphous rash (non-vesicular)
- 5. Cervical lymphadenopathy (≥1.5 cm, usually unilateral)
- INCOMPLETE KD: Fever ≥5 days + 2-3 features + supportive labs/echo
03Action Echocardiogram
Assess coronary arteries
- Obtain echo at diagnosis
- Measure LAD and RCA z-scores
- Z-SCORE INTERPRETATION:
- • Normal: z <2
- • Dilation: z 2-2.5
- • Small aneurysm: z 2.5-5
- • Medium aneurysm: z 5-10
- • Giant aneurysm: z ≥10 or ≥8mm
- Also assess LV function, valves, pericardium
04Decision Risk Stratification (AHA 2024)
High-risk features?
- HIGH-RISK CRITERIA:
- • Age ≤6 months
- • Z-score ≥2.5 in LAD or RCA at diagnosis
- High-risk patients may benefit from intensified initial therapy
05Action Standard Treatment
IVIg + Aspirin
- IVIg 2 g/kg IV over 10-12 hours
- Single infusion preferred
- ASPIRIN:
- • High-dose: 30-50 mg/kg/day or 80-100 mg/kg/day divided q6h
- • Continue until afebrile 48-72 hours
- • Then low-dose: 3-5 mg/kg/day (max 81 mg)
- Continue low-dose aspirin 6-8 weeks minimum
- (longer if CAA present)
06Decision Response to IVIg?
Afebrile within 36-48 hours?
07Outcome Follow-Up Care
Based on coronary artery involvement
- REPEAT ECHO:
- • 2 weeks after treatment
- • 6-8 weeks after illness onset
- • More frequent if CAA present
- NO CAA: Low-dose aspirin 6-8 weeks
- CAA PRESENT:
- • Continue aspirin indefinitely
- • Add anticoagulation for giant aneurysms
- • Cardiology follow-up
- • Activity restrictions based on severity
08Warning IVIg-Refractory KD
Persistent or recurrent fever >36h after IVIg
- OPTIONS:
- • Second dose IVIg 2 g/kg
- • Infliximab 5-10 mg/kg if not already given
- • Methylprednisolone pulse 30 mg/kg x3 days
- • Cyclosporine for refractory cases
- Consult pediatric cardiology/rheumatology
- Path rejoins step 07Shared downstream outcome
09Action High-Risk: Intensified Therapy
Consider adjunctive treatment
- IVIg 2 g/kg + Aspirin
- +
- ADJUNCTIVE OPTIONS:
- • Corticosteroids: Methylprednisolone 2 mg/kg/day or pulse
- • Infliximab: 5-10 mg/kg IV (single dose)
- Limited data for anakinra, cyclosporine
- Path rejoins step 06Shared downstream outcome
Guideline Source
AHA Scientific Statement: Update on Diagnosis and Management of Kawasaki Disease 2024
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Incomplete/atypical KD diagnosis challenging
- Optimal adjunctive therapy still debated
- Long-term follow-up protocols vary by severity
Applicable Regions
USEU
Version 1Next review: 2027-01-11
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Related Resources
Frequently Asked Questions
What is the Kawasaki Disease (AHA 2024)?
The Kawasaki Disease (AHA 2024) is a management clinical algorithm for Pediatrics. It provides a structured decision tree to guide clinical decision-making, based on AHA Scientific Statement: Update on Diagnosis and Management of Kawasaki Disease 2024.
What guideline is the Kawasaki Disease (AHA 2024) based on?
This algorithm is based on AHA Scientific Statement: Update on Diagnosis and Management of Kawasaki Disease 2024 (DOI: 10.1161/CIR.0000000000001295).
What are the limitations of the Kawasaki Disease (AHA 2024)?
Known limitations include: Incomplete/atypical KD diagnosis challenging; Optimal adjunctive therapy still debated; Long-term follow-up protocols vary by severity. Individual patient factors may require deviation from these recommendations.
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