Clinical Pathways

Kawasaki Disease Clinical Pathway

Coronary assessment, PHN / Lopez 2017 coronary Z-score calculation and current AHA classification for paediatric Kawasaki disease.

Coronary Z-score assessment and longitudinal follow-up

This clinician-facing pathway calculates pediatric LMCA, proximal LAD and proximal RCA Z-scores using the Pediatric Heart Network / Lopez 2017 reference model and Haycock body surface area, then maps the result to the current American Heart Association Kawasaki coronary category. It supports structured paediatric cardiology review of measurements, source provenance, high-risk features and longitudinal follow-up; it does not independently diagnose Kawasaki disease or replace specialist review.

Is there a coronary Z-score calculator for Kawasaki disease?

Yes. The ZED Cardio Kawasaki pathway calculates coronary artery Z-scores for the LMCA, proximal LAD and proximal RCA using the Pediatric Heart Network / Lopez 2017 reference model and Haycock body surface area. The calculated Z-scores are then interpreted using the current American Heart Association Kawasaki coronary classification.

AHA Scientific Statement pathway

AHA classification, evaluation & management

Web pathway

AHA classification is applied to coronary Z-scores calculated using the fixed PHN / Lopez 2017 reference model. The AHA does not mandate this model; it is ZED Cardio’s implementation choice for consistent serial interpretation.

Reference lockCoronary Z-score reference: Pediatric Heart Network / Lopez 2017

ZED Cardio uses a single fixed coronary reference model to support consistent serial interpretation. Different validated coronary Z-score models may yield different values.

Fixed model

Patient profile

Body-size context

AgeyearsSexHeightcmWeightkg

BSA—Haycock method · PHN model

Kawasaki / illness context

Assessment context

Assessment typeIllness dayday of fever onset = day 1IVIG status

Echo-first assessment

Coronary echocardiographic measurements

Enter coronary diameter in millimetres. The fixed PHN / Lopez model calculates the Z-score for each supported segment.

LMCA

Left main coronary artery

mm · Z

Measured diameter (mm)

Enter a positive diameter to calculate and classify this vessel.

LAD

Proximal left anterior descending coronary artery

mm · Z

Measured diameter (mm)

Enter a positive diameter to calculate and classify this vessel.

RCA

Proximal right coronary artery

mm · Z

Measured diameter (mm)

Enter a positive diameter to calculate and classify this vessel.

Z-score reference: Pediatric Heart Network / Lopez 2017 · AHA classification: 2024 American Heart Association Kawasaki Disease framework.

AHA classification

Coronary summary

LMCANo measurementZ —Incomplete

LADNo measurementZ —Incomplete

RCANo measurementZ —Incomplete

Current AHA coronary categoryIncomplete — enter a supported coronary diameter

This is the current category from this examination. Longitudinal AHA risk-level subclasses require historical maximum and current coronary status and are not assigned here.

Corrected AHA Figure 1

AHA Kawasaki Disease Evaluation & Management

One focused clinical pathway connecting presentation, coronary assessment, governed Z-score context, classification and acute management.

Clinical criteria

Fever for at least 4 days plus at least 4 of 5 principal features: polymorphous rash; bilateral non-exudative bulbar conjunctival injection; oral changes; palmar/plantar erythema or swelling; and cervical lymphadenopathy ≥1.5 cm.

Supports application of the AHA Kawasaki Disease pathway; does not independently establish the diagnosis.

AHA high-risk assessment

No high-risk feature identified from entered data

AHA high-risk features: age ≤6 months, baseline LAD Z-score ≥2.5, or baseline RCA Z-score ≥2.5. LMCA alone does not trigger this rule. Current follow-up Z-scores are not treated as baseline values.

Acute evaluation and management

First-line AHA therapyIVIG + aspirin

For patients with high-risk features, AHA guidance supports consideration of intensified initial anti-inflammatory treatment in addition to standard therapy. ZedCardio does not automatically select an adjunctive drug.

Fever ≥38°C at ≥36 hours after completion of first IVIG?

For high-risk or coronary-involved patients, corrected Figure 1 supports repeat echocardiography every 2–3 days or according to cardiology/KD-team assessment.

References and clinical caveat

Coronary Z-score model: Pediatric Heart Network / Lopez 2017, using the fixed PHN coefficients for LMCA, proximal LAD and proximal RCA with Haycock BSA. Different validated coronary Z-score models may yield different values; the AHA does not mandate the PHN / Lopez model.

PHN reference: Pediatric Heart Network Echo Z-Scores. Lopez L et al. Relationship of Echocardiographic Z Scores Adjusted for Body Surface Area to Age, Sex, Race, and Ethnicity: The Pediatric Heart Network Normal Echocardiogram Database. Circ Cardiovasc Imaging. 2017;10:e006979. DOI: 10.1161/CIRCIMAGING.117.006979.

Current AHA statement: Jone PN et al. Update on Diagnosis and Management of Kawasaki Disease: A Scientific Statement From the American Heart Association. Circulation. 2024;150:e481–e500. DOI: 10.1161/CIR.0000000000001295.

2017 AHA statement: McCrindle BW et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation. 2017;135:e927–e999. DOI: 10.1161/CIR.0000000000000484.

Corrections incorporated: February 25, 2025, DOI: 10.1161/CIR.0000000000001313; April 1, 2025, DOI: 10.1161/CIR.0000000000001324.

For professional clinical use. Results should be interpreted within the clinical context and the applicability of the cited reference model.
ZedCardio supports application of published reference models and clinical pathways; it does not replace specialist clinical judgement or local Kawasaki disease protocols.