Kawasaki Disease: Factors Associated with Shortterm Outcomes, Impact of Hospital Volume, and Incidence of Disease Burden Among Children in the United States.

摘要

Purpose: Kawasaki disease (KD) is a rare disease of unknown etiology and the leading cause of acquired heart disease among children. An estimated 1,800 new cases are diagnosed in the United States (U.S.) every year. This study examined hospitalizations in children [0 -21 years old] in the U.S. to measure the significance of the disease. Method: Using the Kids Inpatient Database (KID), a retrospective, observational cohort study was performed employing bivariate and multivariate regression techniques to investigate patient and hospital characteristics associated with unfavorable discharge, cardiac complications, length of stay (LOS) and hospital charges. Results: Overall, 13818 pediatric patients were registered in the KID 2003, 2006, 2009, and 2012. The mean age of the cohort was 3.33 ??3.36 years of age 59% were male; 44% were Caucasian; and the highest incidence occurred in the Southern regions during winter and spring. The mean LOS was 3.66 days. The most significant factor associated with unfavorable discharge, cardiac complications, LOS and inflation of adjusted charges was lack of intravenous immunoglobulin therapy (IVIgG). Patients who received IVIgG therapy were 71% less likely to experience cardiac complications. Other factors affecting outcome included income and treatment from a high-volume center. Conclusions: This study identified that IVIgG therapy in a high-volume center resulted in less incidence of cardiac complications, costs and length of stay among children with KD. Therefore, emphasis should be placed on developing an IVIgG therapy standard treatment protocol for KD.