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].