1175. Epidemiology, Clinical Presentation and Outcomes of Kawasaki Disease among Hospitalized Children in an Inner City Hospital Before and After  Publication of the American Heart Association Guidelines for Treatment of Kawasaki Disease- An 11 Year Period
Session: Poster Abstract Session: Kawasaki Disease
Saturday, October 22, 2011
Room: Poster Hall B1
Background: The incidence and epidemiology of Kawasaki disease (KD) varies among races and different regions within the US. Data on epidemiology of KD from the Greater Detroit area is lacking. The effect of the 2004 KD guidelines by American Heart Association (AHA) on the diagnosis and outcome of KD is also lacking. Our objectives were to study the epidemiology of KD in an inner city tertiary care center and to compare the incidence, clinical presentation and outcome of KD before and after the publication of AHA KD treatment guidelines

Methods:  Retrospective chart review conducted for patients <18 years (yrs) admitted to Children's Hospital of Michigan with diagnosis of KD (Jan 99- Dec 09). Incidence per 100,000 population ≤ 5 years, demographics, clinical presentation, laboratory findings (CBC, ESR, CRP, albumin, LFTs, sterile pyuria) and response to treatment (coronary artery abnormality (CAA), length of stay (LOS)) were noted. Comparison was made between those admitted before (2000-04, Pre) and after (2005-09, Post) publication of AHA KD treatment guidelines

Results: 312 children with final diagnosis of KD were included; 199(64%) were AA, 72(23%) White and 7(2%) Asian. 189(61%) were boys. Mean age was 42 months (2 mo-17 yrs). 245(79%) were complete KD. 206(66%) were admitted in winter and spring. Mean days of fever (DOF) on admission were 5.6 days and LOS 6.4 days. There was a significant increase in cases of KD over the last 11 years (p= 0.0001), also in the Post period. Pre and Post periods were compared (Table). There was no significant difference in age, gender, race distribution or seasonality and laboratory findings between the 2 groups.

Parameter

Pre

N= 111

Post

N= 176

p value

Mean incidence < 5 yrs/100,000 children

5.9

10.2

0.02

Incomplete KD, N (%)

19 (17)

40 (23)

0.25

Mean DOF at treatment initiation

5

6

0.09

CAA, N

26

25

0.08

>2 dose of IVIG needed, N (%)

1 (1)

5 (3)

0.40

Mean LOS (days)

7.5

6

0.88

History of readmission, N

6

5

0.27

Conclusion: KD admissions in the Greater Detroit area significantly increased during the Post period, which may be due to increased awareness about KD after publication of KD treatment guidelines or a true increase in incidence. However there was no difference in the clinical presentation, laboratory findings or the outcome of KD between the two groups


Subject Category: J. Clinical practice issues

Swati Arya, MD1, Jocelyn Ang, MD2, Xinguang Chen, MD, PhD3 and Yifan Jiang3, (1)Pediatrics, Children's Hospital of Michigan, Detroit, MI, (2)Children's Hospital of Michigan/Wayne State University, Detroit, MI, (3)Wayne State University School Of Medicine, Detroit, MI

Disclosures:

S. Arya, None

J. Ang, None

X. Chen, None

Y. Jiang, None

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