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Original article
Immunoglobulin for Kawasaki disease: a 3-year retrospective audit
  1. Beth Pascall1,
  2. Arjuna Thakker2,
  3. Ying Foo1,
  4. Pradip Thakker1
  1. 1 Paediatrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2 University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
  1. Correspondence to Dr Beth Pascall; elizabeth.pascall{at}nhs.net

Abstract

Aim To evaluate whether intravenous immunoglobulin (IVIG) use in children with suspected Kawasaki disease (KD) was given according to local trust and the newly revised American Heart Association (AHA) guidelines.

Methods In our tertiary hospital, any child with suspected KD given IVIG, over the past 3 years, was identified. Their electronic notes were then reviewed.

Results Ten patients were identified. Nine patients had a fever lasting 5 days or more. Four patients had either 5/5 or 4/5 of the diagnostic criteria for KD and were diagnosed with complete KD. The remaining six patients were suspected to have incomplete KD. 7/10 patients received IVIG within 10 days of onset of illness. Patients suspected to have incomplete KD experienced a mean delay in administration of IVIG of 5.3 days compared with those with complete KD. In four patients, an alternative diagnosis was established. Three patients had coronary artery abnormalities on first echocardiogram. From these patients, only one had a follow-up echocardiogram recorded in their notes. No patient had more than one follow-up echocardiogram (at both 2 and 6 weeks).

Conclusion Identifying patients with incomplete KD is more difficult than identifying those with complete KD and any delay in giving IVIG could be due to this reason. This audit suggests that increasing awareness of incomplete KD and a clear guideline will aid prompter diagnosis and administration of IVIG. This audit also suggests that all patients with KD should receive more than one follow-up echocardiogram.

  • audit
  • cardiology
  • general paediatrics
  • immunoglobulins
  • delayed diagnosis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors PT presented the idea of this audit and supervised the process. BP, FY and AT contributed to collecting the data and writing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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