Balancing Value and Risk in Early Discharge of Patients With Kawasaki Disease

Kawasaki disease (KD) continues to present clinicians with challenges and uncertainties. When diagnosing and treating KD, lack of a definitive diagnostic test, symptom overlap, and atypical presentations can perplex even experienced physicians. Treatment is costly because of hospitalization and subspecialist follow-up. Although concerns exist that KD may be overdiagnosed,1 a missed diagnosis of KD may have severe consequences. A particular challenge for clinicians caring for a child with KD is the timing of discharge. Because 10% to 20% of patients are refractory to initial therapy with intravenous immune globulin (IVIg),2 clinicians must decide how long to observe patients post-IVIg treatment and when to retreat if fever recurs, understanding that IVIg can also cause fever.3 The American Heart Association KD guidelines do not specify post-IVIg observation time,2 which varies between clinicians.4 KD is estimated to account for 5000 to 6000 hospitalizations a year in the United States5 with an average length of stay of 3 days.6 Identifying patients at low risk for IVIg resistance could characterize patients safe for early discharge and may reduce costs and resource use. In this month’s issue of Hospital Pediatrics , Hester et al7 present an IVIg nonresponse risk model from the angle of high-value …