title: Variability in delivery of care and echocardiogram surveillance of Kawasaki disease.
abstract: OBJECTIVE
  The objective of this study is to characterize variability in the acute management of Kawasaki disease and compliance of echocardiogram surveillance with published American Heart Association recommendations.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Tertiary care children's hospital.
  
  
  METHODS
  All patients discharged from our institution with Kawasaki Disease between 1999 and 2007 were identified. Patients meeting any of the following were excluded: presence of a comorbidity that necessitated echocardiogram follow-up independent of Kawasaki disease diagnosis, previous history of Kawasaki disease, or magnetic resonance imaging of the coronary arteries performed in place of echocardiography. Preexisting or comorbid conditions resulting in study exclusion included structural heart disease, arrhythmia, and concomitant severe multiorgan disease at presentation (e.g., sepsis).
  
  
  METHODS
  The time course of echocardiogram surveillance among those with a normal echocardiogram at diagnosis was evaluated for compliance with published American Heart Association recommendations. Coronary artery involvement at presentation was characterized using standardized values. Additional characterization of national care practices for children with Kawasaki disease was obtained via distribution of an internet-based survey to pediatric hospitalists.
  
  
  RESULTS
  Overall, only 11 (4%) of 302 patients with a normal study at diagnosis received a total of three studies at recommended intervals. Using standardized values for coronary artery dimensions in place of Japanese Ministry of Health aneurysm criteria, 59 (13%) of patients with Kawasaki disease experienced coronary artery involvement at diagnosis. The majority of the early coronary artery abnormalities detected in these patients using standardized definitions persisted on short-term follow-up. Pediatric hospitalist survey results revealed significant interinstitutional variability in the management of these patients.
  
  
  CONCLUSIONS
  Lack of optimal surveillance after a diagnosis of Kawasaki disease may result in the underdiagnosis of coronary artery pathology or other complications. Considerable variability in surveillance and acute management exists, and additional research is needed to determine optimal screening and care delivery models for this population.
authors.affiliation: Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA. lowry@bcm.edu
authors.forename: Adam W
authors.initials: AW
authors.lastname: Lowry
authors.forename: Jarrod D
authors.initials: JD
authors.lastname: Knudson
authors.forename: Barry L
authors.initials: BL
authors.lastname: Myones
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Moodie
authors.forename: Yong S
authors.initials: YS
authors.lastname: Han
mesh_terms: D002648:Child; D002675:Child, Preschool; D019983:Guideline Adherence; D006801:Humans; D009080:Mucocutaneous Lymph Node Syndrome / Q000000981:diagnostic imaging* / Q000628:therapy*; D011159:Population Surveillance; D012189:Retrospective Studies; D014463:Ultrasonography