1172. Variation in Management of Children with Kawasaki Disease in U.S. Hospitals: Is it Time for a More Consistent Approach?
Session: Poster Abstract Session: Kawasaki Disease
Saturday, October 22, 2011
Room: Poster Hall B1

Background: The most recent guidelines for management of patients with Kawasaki Disease (KD) were published by the American Heart Association (AHA) in 2004. Since then, new information regarding treatment of IVIG resistant disease has been published. We describe current management of KD in U.S. Children's hospitals.

Methods: An email survey regarding KD was sent to the heads of pediatric infectious disease(ID), pediatric cardiology and pediatric rheumatology in 42 U.S. free standing Children's hospitals.

Results: We received responses from 35 institutions (83%). KD patients were admitted to general pediatrics/hospitalist services in 73% of institutions.  Both ID specialists and Cardiologists were consulted in 77% of hospitals. 61% of institutions reported that ID specialists primarily directed the management of KD patients. The majority of institutions estimated that 10-24% of cases were incomplete KD. All KD patients had a CBC, CRP, ESR, liver function tests and ECHO at admission. Fifty-eight percent of institutions did not repeat a CRP after IVIG. IVIG resistant disease was reported to occur in 10-25% of KD patients by the majority of institutions. In 39% of institutions, patients with persistent or recrudescent fever ≥ 24 hours after completion of IVIG were re-treated, while 29% of institutions retreated for fever at ≥ 36 hours and 26% at ≥48 hours.

All institutions retreated with a second dose of IVIG. Third line therapy was methyl prednisolone in 57% and infliximab in 37%. Only 69% of hospitals used high dose aspirin (80-100mg/kg/day) in the acute phase and 2 hospitals reported they did not use aspirin. In the 8-10 weeks after diagnosis, 57% of the hospitals did 2 ECHOs and 30% did 3 ECHOs. Patients with normal ECHOs at one year were not seen beyond the first year in 79% of hospitals but were seen 3-5 years after discharge in 12% of hospitals. Only 43% of hospitals reported their cases to the CDC. Eighty two percent of institutions felt the AHA guidelines were moderately to extremely useful.

Conclusion: This survey was completed by treating physicians from 35 large free standing U.S. Children's hospitals and demonstrates variation in management of KD patients. This is particularly evident in the timing of retreatment and in third line treatment for refractory cases.


Subject Category: P. Pediatric and perinatal infections

Mohammed Eladawy, MD, PhD1, Marsha Anderson, MD2, Samuel Dominguez, MD, PhD1 and Mary Glode, MD, FIDSA1, (1)Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, (2)Pediatrics, Department of Pediatrics, Children's Hospital Colorado and University of Colorado Health Science Center, Aurora, CO

Disclosures:

M. Eladawy, None

M. Anderson, None

S. Dominguez, None

M. Glode, None

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