Kawasaki disease is a clinical diagnosis. It is important to realise that the principle clinical features can appear and disappear by the time of assessment. A careful history may reveal that principal clinical features were present during the early phase of the illness but have resolved by the time of presentation. It is also important to note that the characteristic features of Kawasaki disease are less common in children under 1 year.

The 2013 NICE guideline “Fever in under 5’s” recommended Kawasaki disease be considered when a child has a fever lasting five days or more, and 4 of the 5 principal features of Kawasaki disease specified by the American Heart Association diagnostic criteria3.

Strict adherence to these criteria identified less than half of the patients with Kawasaki disease, which lead to new recommendations on Kawasaki disease in the updated 2019 NICE guideline. NG143 promotes the recognition of “incomplete” Kawasaki Disease i.e. persistent fever associated with fewer than 4 of the 5 principal clinical features.

The emergency department clinician must consider Kawasaki disease in all children with a persistent fever for five days or longer, and actively inquire about the presence of the other principal clinical features which may increase the diagnostic likelihood of Kawasaki disease.

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Clinical features may have disappeared by the time of assessment.

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