Factors Associated With Resource Utilization and Coronary Artery Dilation in Refractory Kawasaki Disease (from the Pediatric Health Information System Database).
Management guidelines for refractory Kawasaki disease (KD) are vague. We sought to assess practice variation and identify factors associated with large/complex coronary artery aneurysms (LCAA) and resource utilization in refractory KD. This retrospective cohort study identified patients aged ≤18 years with KD (2004 to 2014) using the Pediatric Health Information System. Refractory KD was defined as receiving >1 dose of intravenous immunoglobulin. Demographics, medications, concomitant infections, length of stay (LOS), and charges were collected. Antithrombotic therapy was a surrogate for LCAA. LOS and hospital charges assessed resource utilization. Multivariate regression identified factors associated with LOS, charges, and LCAA. Of 14,194 patients with KD, 2,974 (21%) had refractory KD and 203 of those 2,974 (7%) had LCAA. Additional intravenous immunoglobulin was the sole medication in 77%. Other medications added were steroids (18%), infliximab (2%), and both (3%). Warfarin, low-molecular-weight heparin, tissue plasminogen activator, and clopidogrel were prescribed with equal frequency (2%). Male gender (adjusted relative risk 1.52, 95% confidence interval [CI] 1.08 to 2.16, p <0.01), admission to an intensive care unit (4.79, 95% CI 3.40 to 6.74, p <0.001), arrhythmia (3.00, 95% CI 1.94 to 4.65, p <0.001), and concomitant viral infection (2.29, 95% CI 1.49 to 3.52, p <0.001) were associated with LCAA. Severe illness, race, region, and payer were independently associated with increased charges (p <0.05 for all). In conclusion, treatment for refractory KD varies widely. Concomitant viral infection was associated with a greater risk of LCAA in refractory KD. Better understanding of optimal management may improve outcomes and decrease both variability in management and resource utilization for refractory KD.
Department of Pediatric Cardiology, University of Utah at Primary Children's Hospital, Salt Lake City, Utah. Electronic address: Jennifer.Lo@hsc.utah.edu.
Jennifer Y
JY
Lo
Department of Pediatric Cardiology, University of Utah at Primary Children's Hospital, Salt Lake City, Utah.
L LuAnn
LL
Minich
Department of Pediatric Cardiology, University of Utah at Primary Children's Hospital, Salt Lake City, Utah.
Lloyd Y
LY
Tani
Department of Pediatrics, University of Utah, Salt Lake City, Utah.
Jacob
J
Wilkes
Study Design and Biostatistics Center, University of Utah School of Medicine, Salt Lake City, Utah.
Qian
Q
Ding
Department of Pediatric Cardiology, University of Utah at Primary Children's Hospital, Salt Lake City, Utah.
Shaji C
SC
Menon
D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D063005:Health Information Systems / Q000706:statistics & numerical data*; D006295:Health Resources; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000188:drug therapy; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors