FaxNotes from Children’s Medical Center

FaxNotes
from Children’s Medical Center
Dallas, Texas
A M O N T H LY U P D AT E F O R T H E P H Y S I C I A N C O M M U N I T Y
• JUNE 2010
GRAND ROUNDS
MEDICAL UPDATE: Atypical or incomplete Kawasaki Disease
There are no Grand Rounds scheduled. Grand
Rounds will resume in September.
To ensure prompt diagnosis and
treatment of patients with incomplete or
atypical Kawasaki Disease, the American
Heart Association published guidelines for
the diagnosis, treatment and long-term
management of these patients in 2004
(http://circ.ahajournals.org/cgi/reprint/11
0/17/2747). An algorithm was developed
for the evaluation of patients with suspected incomplete KD that should be used for
evaluating these patients. This should be
part of every pediatric practice, and all
patients with Kawasaki Disease should be
followed by a cardiologist.
Diagnosis of classic Kawasaki Disease
includes fever ≥5 days, and presence of at
least four of the following: edema or peeling of skin on the extremities, polymorphous rash, bilateral non-exudative conjunctivitis, red lips and mouth and/or unilateral cervical adenopathy > 1.5 cm.
The children with Kawasaki Disease
(KD) who are most frequently missed are
infants and teens. Infants younger than 6
months may present only with prolonged
fever and few if any signs of KD. Teens
may present with what appears to be a
cervical adenitis, fever and a rash ascribed
to a drug reaction.
Incomplete KD should be considered in
all children with unexplained fever ≥ 5
days with two or three principal clinical
features of KD. Using the algorithm, these
children must get a sedimentation rate
(ESR) and or CRP and if the ESR is ≥ 40
or the CRP ≥ 3.0, then supplemental labs*
must be drawn. If three or fewer of these
supplemental labs are positive, an echocardiogram should be done. If the echo is
positive, admit for IVIG. If three or more
supplemental labs are positive, treat with
IVIG and echo.
In addition, infants 6 months or
younger with fever ≥ 7 days, without
other explanation, should get a ESR or
CRP, and if either is abnormal, should get
an echocardiogram. If the echo is positive, treat with IVIG, even if the infants
have no other clinical criteria of KD.
For more information on our
Kawasaki Disease Clinic, contact Dr.
Candace Gibbin at Children’s Medical
Center at Legacy at 469-303-4300
([email protected])
or Dr. Sarah Blumenschein at
Children’s Dallas at 214-456-2333
([email protected]).
*Supplemental labs: albumin ≤ 3,
increased ALT, anemia, plts > 450K after
7 days, WBC ≥15,000, UA ≥10 WBC/hpf
SERVICE UPDATE: PACT Program helps transition to adult healthcare
For consultations, to admit a
patient, schedule an ambulatory
appointment, or to arrange a
transfer to any location, call
888-730-DOCS(3627).
www.childrens.com
The Pediatric to Adult Care Transition
(PACT) Program at Children’s addresses
the needs of adolescents with chronic illnesses moving toward independent adulthood and allows families to prepare to
transition from pediatric to adult healthcare settings. PACT Education Days provide adolescents and their parents a
review of specific healthcare needs and
the skills needed to be successful in this
process. PACT Education Days include sessions tailored to specific chronic illnesses,
as well as topics related to living successfully as a young adult with chronic illness,
and also transitioning to and communicating in adult medical settings. A concurrent program is offered to help parents
foster assisted independence in adolescents. PACT Education Days are available
for GI, sickle cell disease, cystic fibrosis,
solid organ transplant, and the ARMS
Clinic. A PACT Education Day will be held
on Saturday, July 24, for sickle cell and
cystic fibrosis families. For more information about the cystic fibrosis and sickle
cell diesease program, contact Dr. Jamie
Grollman at 214-456-2976, or
[email protected]