Kawasaki Disease or Incomplete Kawasaki Disease Clinical Pathway — Emergency Department and Inpatient

Laboratory Testing

Laboratory tests typically reveal normal or elevated white blood cell count with neutrophil predominance and elevated acute phase reactants such as C-reactive protein and erythrocyte sedimentation rate during the acute phase. Low serum sodium and albumin levels, elevated serum liver enzymes, and sterile pyuria can be present. In the second week after fever onset, thrombocytosis is common.

Initial Diagnostic Testing	Laboratory studies CBC w/ diff, CRP, ESR CMP UA or Urine POC from bag or clean catch (catheterization will not capture urethritis) Consider: Blood culture Urine culture (from clean catch or catheterization) if pyuria on initial specimen UTI Pathway
Lab Findings in KD	Elevated CRP Elevated ESR Anemia for age Leukocytosis with neutrophils and immature forms Thrombocytosis after 1 week Sterile pyuria Hyponatremia Elevated serum transaminases Elevated serum gamma glutamyl transpeptidase Hypoalbuminemia Abnormal plasma lipids Pleocytosis of CSF Leukocytosis in synovial fluid
Labs for alternative diagnoses	Rapid Strep/Strep culture RRP

American Heart Association. 2017 Mar: Circulation 135:00-00. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. McCrindle et al.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.