119 - ENHANCING GENERAL PRACTITIONERS' AWARENESS: THE CRITICAL ROLE OF EDUCATION IN DIAGNOSING KAWASAKI DISEASE IN CONTEMPORARY MEDICAL PRACTICE

Background/Aim

The education of general practitioners (GPs) during their training and during continuing medical education is critical to successful management of KD prior to pediatric specialist care.

Here, we present a critical case highlighting the challenges in the recognition of KD among GPs in Sweden. A 7-year-old girl with high fever sought medical attention from five different GPs, who were in different stages of training. However, only the most experienced GP correctly identified the condition after 4 weeks of fever. Delayed diagnosis was associated with the development of giant coronary artery aneurysms (CAA), necessitating aggressive immunosuppression for stabilization.

Methods

This is a retrospective case study with in-depth analysis of the medical encounters the patient had with the different primary care providers. The study evaluates the diagnostic approaches, training levels, and decision-making processes of each GP/trainee during the patient's interactions with the provider. Data collected include clinical notes, laboratory results, and imaging reports.

Results

Despite education on KD being included in all training in pediatrics during medical school, we found a disconcerting lack of KD awareness among most GPs encountered by this patient. In this case 4/5 physicians (80%) failed to recognize the clinical manifestations of KD in time. The ensuing diagnostic delay, including multiple failed treatment attempts with antibiotics, was associated with the development of giant CAA in the affected child. Upon correct diagnosis by the fifth GP, immediate first-, second- and third-line treatment was required to stabilize the patient's deteriorating condition. Treatment with IVIG, corticosteroids and biologicals suppressed the inflammation and stabilized the giant CAA. After several years with intense follow-up, exercise-induced chest pain necessitated coronary artery bypass grafting (CABG) in this child, an absolute rarity in modern medicine in Sweden as a highly developed country.

Conclusion

This case underscores the urgent need for heightened awareness and education among GPs regarding the recognition of KD, especially in pediatric patients. The delayed diagnosis in this case was associated with the development of giant CAA, necessitating aggressive immunosuppression for stabilization. The findings highlight the potential consequences of a lack of familiarity with KD symptoms and the importance of early intervention in preventing severe complications. Efforts to enhance continuing GP education on KD are crucial to ensure timely and accurate diagnosis, ultimately improving outcomes for affected children in clinical practice.