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Kuo HC, Hao S, Jin B, Chou CJ, Han Z, Chang LS, Huang YH, Hwa K, Whitin JC, Sylvester KG, Reddy CD, Chubb H, Ceresnak SR, Kanegaye JT, Tremoulet AH, Burns JC, McElhinney D, Cohen HJ, Ling XB. Single center blind testing of a US multi-center validated diagnostic algorithm for Kawasaki disease in Taiwan. Front Immunol 2022; 13:1031387. [PMID: 36263040 PMCID: PMC9575935 DOI: 10.3389/fimmu.2022.1031387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundKawasaki disease (KD) is the leading cause of acquired heart disease in children. The major challenge in KD diagnosis is that it shares clinical signs with other childhood febrile control (FC) subjects. We sought to determine if our algorithmic approach applied to a Taiwan cohort.MethodsA single center (Chang Gung Memorial Hospital in Taiwan) cohort of patients suspected with acute KD were prospectively enrolled by local KD specialists for KD analysis. Our previously single-center developed computer-based two-step algorithm was further tested by a five-center validation in US. This first blinded multi-center trial validated our approach, with sufficient sensitivity and positive predictive value, to identify most patients with KD diagnosed at centers across the US. This study involved 418 KDs and 259 FCs from the Chang Gung Memorial Hospital in Taiwan.FindingsOur diagnostic algorithm retained sensitivity (379 of 418; 90.7%), specificity (223 of 259; 86.1%), PPV (379 of 409; 92.7%), and NPV (223 of 247; 90.3%) comparable to previous US 2016 single center and US 2020 fiver center results. Only 4.7% (15 of 418) of KD and 2.3% (6 of 259) of FC patients were identified as indeterminate. The algorithm identified 18 of 50 (36%) KD patients who presented 2 or 3 principal criteria. Of 418 KD patients, 157 were infants younger than one year and 89.2% (140 of 157) were classified correctly. Of the 44 patients with KD who had coronary artery abnormalities, our diagnostic algorithm correctly identified 43 (97.7%) including all patients with dilated coronary artery but one who found to resolve in 8 weeks.InterpretationThis work demonstrates the applicability of our algorithmic approach and diagnostic portability in Taiwan.
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Affiliation(s)
- Ho-Chang Kuo
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- *Correspondence: Xuefeng B. Ling, ;Ho-Chang Kuo,
| | - Shiying Hao
- School of Medicine, Stanford University, Stanford, CA, United States
| | - Bo Jin
- School of Medicine, Stanford University, Stanford, CA, United States
| | - C. James Chou
- School of Medicine, Stanford University, Stanford, CA, United States
| | - Zhi Han
- School of Medicine, Stanford University, Stanford, CA, United States
| | - Ling-Sai Chang
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ying-Hsien Huang
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuoyuan Hwa
- Center for Biomedical Industry, Department of Molecular Science and Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - John C. Whitin
- School of Medicine, Stanford University, Stanford, CA, United States
| | - Karl G. Sylvester
- School of Medicine, Stanford University, Stanford, CA, United States
| | - Charitha D. Reddy
- School of Medicine, Stanford University, Stanford, CA, United States
| | - Henry Chubb
- School of Medicine, Stanford University, Stanford, CA, United States
| | - Scott R. Ceresnak
- School of Medicine, Stanford University, Stanford, CA, United States
| | - John T. Kanegaye
- Pediatrics, University of California San Diego, San Diego, CA, United States
| | | | - Jane C. Burns
- Pediatrics, University of California San Diego, San Diego, CA, United States
| | - Doff McElhinney
- School of Medicine, Stanford University, Stanford, CA, United States
| | - Harvey J. Cohen
- School of Medicine, Stanford University, Stanford, CA, United States
| | - Xuefeng B. Ling
- School of Medicine, Stanford University, Stanford, CA, United States
- *Correspondence: Xuefeng B. Ling, ;Ho-Chang Kuo,
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Edelson JB, Rossano JW, Griffis H, Quarshie WO, Ravishankar C, O'Connor MJ, Mascio CE, Mercer-Rosa L, Glatz AC, Lin KY. Resource Use and Outcomes of Pediatric Congenital Heart Disease Admissions: 2003 to 2016. J Am Heart Assoc 2021; 10:e018286. [PMID: 33554612 PMCID: PMC7955343 DOI: 10.1161/jaha.120.018286] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Children with congenital heart disease (CHD) are known to consume a disproportionate share of resources, yet there are limited data concerning trends in resource use and mortality among admitted children with CHD. We hypothesize that charges in CHD‐related admissions increased but that mortality improved over time. Methods and Results This study, including patients <18 years old with CHD, examined inpatient admissions from the nationally representative Kids' Inpatient Database from 2003 to 2016 in order to assess the frequency, medical complexity, and outcomes of CHD hospital admissions. A total of 859 843 admissions of children with CHD were identified. CHD admissions increased by 31.8% from 2003 to 2016, whereas overall pediatric admissions decreased by 13.4%. Compared with non‐CHD admissions, those with CHD were more likely to be <1 year of age (80.5% versus 63.3%), and to have ≥1 complex chronic condition (39.7% versus 9.3%). For CHD admissions, mortality was higher (2.97% versus 0.31%) and adjusted median charges greater ($48 426 [interquartile range (IQR), $11.932–$161 048] versus $4697 [IQR, $2551–$12 301]) (P<0.0001 for all). Among CHD admissions, whereas adjusted median charges increased from $35 577 (IQR, $9303–$110 439) to $61 696 (IQR, $15 212–$219 237), mortality decreased from 3.2% to 2.7% (P for trend <0.0001). CHD admissions accounted for an increased proportion of all inpatient deaths, from 18.0% in 2003 to 24.5% in 2016. Conclusions Children admitted with CHD are 10 times more likely to die than those without CHD and have higher charges. Although the rate of mortality in CHD admissions decreased, children with CHD accounted for an increasing proportion of all pediatric inpatient deaths. Effective resource allocation is critical to optimize outcomes in these high‐risk patients.
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Affiliation(s)
- Jonathan B Edelson
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA.,Cardiovascular OutcomesQuality and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health EconomicsUniversity of Pennsylvania Philadelphia PA
| | - Joseph W Rossano
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA.,Cardiovascular OutcomesQuality and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health EconomicsUniversity of Pennsylvania Philadelphia PA
| | - Heather Griffis
- Department of Biomedical Health Informatics Healthcare Analytics Unitthe Children's Hospital of Philadelphia PA
| | - William O Quarshie
- Department of Biomedical Health Informatics Healthcare Analytics Unitthe Children's Hospital of Philadelphia PA
| | - Chitra Ravishankar
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Matthew J O'Connor
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Christopher E Mascio
- Division of Cardiothoracic Surgery Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Laura Mercer-Rosa
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Andrew C Glatz
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Kimberly Y Lin
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
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Edelson JB, Rossano JW, Griffis H, Dai D, Faerber J, Ravishankar C, Mascio CE, Mercer-Rosa LM, Glatz AC, Lin KY. Emergency Department Visits by Children With Congenital Heart Disease. J Am Coll Cardiol 2019; 72:1817-1825. [PMID: 30286926 DOI: 10.1016/j.jacc.2018.07.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/15/2018] [Accepted: 07/12/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data related to the epidemiology and resource utilization of congenital heart disease (CHD)-related emergency department (ED) visits in the pediatric population is limited. OBJECTIVES The purpose of this analysis was to describe national estimates of pediatric CHD-related ED visits and evaluate medical complexity, admissions, resource utilization, and mortality. METHODS This was an epidemiological analysis of ED visit-level data from the 2006 to 2014 Nationwide Emergency Department Sample. Patients age <18 years with CHD were identified using International Classification of Diseases-9th Revision-Clinical Modification codes. We evaluated time trends using weighted regression and tested the hypothesis that medical complexity, resource utilization, and mortality are higher in CHD patients. RESULTS A total of 420,452 CHD-related ED visits (95% confidence interval [CI]: 416,897 to 422,443 visits) were identified, accounting for 0.17% of all pediatric ED visits. Those with CHD were more likely to be <1 year of age (43% vs. 13%), and to have ≥1 complex chronic condition (35% vs. 2%). CHD-related ED visits had higher rates of inpatient admission (46% vs. 4%; adjusted odds ratio: 1.89; 95% CI: 1.85 to 1.93), higher median ED charges ($1,266 [interquartile range (IQR): $701 to $2,093] vs. $741 [IQR: $401 to $1,332]), and a higher mortality rate (1% vs. 0.04%; adjusted odds ratio: 1.25; 95% CI: 1.07 to 1.45). Adjusted median charges for CHD-related ED visits increased from $1,219 (IQR: $673 to $2,138) to $1,630 (IQR: $901 to $2,799), while the mortality rate decreased from 1.13% (95% CI: 0.71% to 1.52%) to 0.75% (95% CI: 0.41% to 1.09%) over the 9 years studied. CONCLUSIONS Children with CHD presenting to the ED represent a medically complex population at increased risk for morbidity, mortality, and resource utilization compared with those without CHD. Over 9 years, charges increased, but the mortality rate improved.
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Affiliation(s)
- Jonathan B Edelson
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Joseph W Rossano
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Heather Griffis
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dingwei Dai
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer Faerber
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chitra Ravishankar
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher E Mascio
- Department of Pediatrics, Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Laura M Mercer-Rosa
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andrew C Glatz
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kimberly Y Lin
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Sacks JH, Kelleman M, McCracken C, Glanville M, Oster M. Pediatric cardiac readmissions: An opportunity for quality improvement? CONGENIT HEART DIS 2016; 12:282-288. [DOI: 10.1111/chd.12436] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/12/2016] [Accepted: 09/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Jeffrey H. Sacks
- Children's Healthcare of Atlanta; Atlanta GA USA
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
| | - Michael Kelleman
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
| | - Courtney McCracken
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
| | | | - Matthew Oster
- Children's Healthcare of Atlanta; Atlanta GA USA
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
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