Division of Immunology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
J Pediatr. 2021 May;232:127-132.e3. doi: 10.1016/j.jpeds.2021.01.007. Epub 2021 Jan 13.
To determine predictors of >1 emergency department (ED) visit for a Kawasaki disease diagnosis in a quaternary care pediatric hospital and compare outcomes between patients with 1 vs >1 visit for Kawasaki disease diagnosis.
Medical records of patients evaluated for Kawasaki disease between January 2006 and August 2018 at Boston Children's Hospital were abstracted for demographic and clinical data. Predictors of >1 visit were explored using logistic regression and classification and regression tree analysis.
Of 530 patients diagnosed with Kawasaki disease, 117 (22%) required multiple ED visits for Kawasaki disease diagnosis. Multivariable regression and classification and regression tree analysis identified ≤2 Kawasaki disease criteria (OR 33.9; 95% CI 18.1-63.6), <3 days of fever at the first visit (OR 3.47; 95% CI 1.77-6.84), and non-White race (OR 2.15; 95% CI 1.18-3.95) as predictors of >1 visit. There were no significant differences in duration of hospitalization, day of illness at initial Kawasaki disease treatment, intravenous immunoglobulin resistance, need for adjunctive therapies, or coronary artery outcomes between patients diagnosed with Kawasaki disease at initial visit vs subsequent visits.
Incomplete Kawasaki disease criteria, fewer days of fever, and non-White race were significant predictors of multiple ED visits for Kawasaki disease diagnosis in this single institution study. Our findings underscore the importance of maintaining a high index of suspicion for Kawasaki disease in patients with <4 Kawasaki disease criteria. Further research is needed to determine causes for increased healthcare use in non-White patients to receive a Kawasaki disease diagnosis.
确定在一家四级儿科医院中，因川崎病诊断而多次前往急诊部（ED）的预测因素，并比较因川崎病诊断而多次前往 ED 的患者与仅一次前往 ED 的患者的结局。
从 2006 年 1 月至 2018 年 8 月在波士顿儿童医院接受川崎病评估的患者的病历中提取人口统计学和临床数据。使用逻辑回归和分类回归树分析来探讨多次就诊的预测因素。
在诊断为川崎病的 530 例患者中，有 117 例（22%）需要多次前往 ED 以明确川崎病的诊断。多变量回归和分类回归树分析确定，川崎病诊断标准数≤2（比值比 33.9；95%置信区间 18.1-63.6）、首次就诊时发热<3 天（比值比 3.47；95%置信区间 1.77-6.84）和非白人种族（比值比 2.15；95%置信区间 1.18-3.95）是多次就诊的预测因素。首次就诊时即被诊断为川崎病的患者与后续就诊的患者相比，住院时间、初始川崎病治疗时的发病天数、静脉注射免疫球蛋白耐药性、辅助治疗需求或冠状动脉结局均无显著差异。
在本单机构研究中，川崎病诊断标准不完整、发热天数较少和非白人种族是多次前往 ED 就诊的重要预测因素。我们的研究结果强调了在川崎病诊断标准数<4 的患者中保持对川崎病高度怀疑的重要性。需要进一步研究以确定导致非白人患者增加医疗保健利用以获得川崎病诊断的原因。
