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Rise observed in hospital discharges of patients with Kawasaki disease
The number of patients discharged with Kawasaki disease rose by nearly 50% between 2004 and 2013, according to findings presented at Cardiology 2017.
Researchers also found seasonal and regional variations in discharge patterns.
“There are inconsistent reports of seasonal distributions of [Kawasaki disease] in specific regions of the country and globally,” Svetlana Shugh, MD, a second-year fellow at Baylor College of Medicine, and colleagues wrote in the abstract. “We sought to identify trends in the diagnosis of [Kawasaki disease] with respect to seasonal variability, geographic region and ethnicity in the United States.”
Researchers gathered data from the Pediatric Health Information System from 2004 to 2013. Data from patients with acute Kawasaki disease who also received IV immunoglobulin were analyzed. Patients were then categorized by geographic regions, which were determined using the U.S. Census Bureau’s definition of the Northeast, South, Midwest and West.
Throughout the 10-year period, 14,325 patients (61% male) were discharged with acute Kawasaki disease. Their ages ranged from younger than 1 month to 20 years, with an average age of 3 years. Overall, hospital discharges for Kawasaki disease rose by 47% (P < .001), according to the data.
Patients from the South accounted for 36% of the discharges, whereas 26% from the West, 25% were from the Midwest and 12% from the Northeast. Hispanic patients accounted for 45% of the discharges in the West, 28% in the South, 21% in the Midwest and 17% in the Northeast.
Researchers wrote in an abstract that discharges for patients with acute Kawasaki disease in the South increased by 87% over 10 years (P < .001). Discharges of patients with Kawasaki disease also increased in the South by 0.6%, (13.4 per 1,000 to 19.2 per 1,000; P < .001), the Northeast by 0.2% and the West by 0.1%. Discharges in the Midwest decreased by 0.2%.
Forty percent of discharges took place December to March. Most discharges in the South occurred in January. Most patients from the Northeast were discharged in February, whereas the highest rates of discharges in the West and Midwest were in March.
“This does not suggest that the patient’s condition has improved over those months,” Shugh told Cardiology Today. “Rather, those are the months of highest admissions and discharges for Kawasaki disease. There is a suspected underlying infective agent given the winter predominance, that cases are most often seen in young children, and community outbreaks have been reported.
“We need to maintain a higher degree of suspicion in general for Kawasaki disease and incomplete Kawasaki disease nationwide, as the rate of Kawasaki disease is rising,” Shugh told Cardiology Today. “This study particularly indicates a need to be vigilant and have a high suspicion for Kawasaki disease among patients of Hispanic ethnicity in the Southern region.”– by Darlene Dobkowski
Reference:
Shugh S, et al. Abstract 215. Presented at: Cardiology: the 20th Annual Update on Pediatric and Congenital Cardiovascular Disease; Feb. 22-26, 2017; Orlando, Fla.
Disclosure: Shugh reports no relevant financial disclosures.
Editor’s Note: This article was updated on March 22, 2017, with a minor change to the data and other new information.
Perspective
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The data have been previously reported in the consortium, “Seasonality of Kawasaki Disease: A Global Perspective” (Burns JC, et al. PLoS One. 2013;doi:10.1371/journal.pone.0074529).
The findings of this study have influences on clinical practice, as it provides a heightened awareness of Kawasaki disease during the winter and flu season. It is very important for practicing community pediatricians to recognize the seasonal variation of this disease and for hospital-based ED staff and attending physicians to have lower thresholds for ordering ECGs and treating Kawasaki disease during the colder months.
The patients do not have improved conditions during the months when most discharges occur, but rather susceptibility to viral and bacterial infections that likely contribute to the evolution of the disease.
The abstract reports percentages of discharge diagnoses, which has limitations. Nevertheless, seasonal variation was noted in Japan over a decade ago, and we experience a similar thing here at CHOP. Therefore, there is little reason to doubt the observation is true. There is a lot of Kawasaki research that has been done worldwide.