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American Academy of Pediatrics
Research Articles

Variations in Sedated Echocardiography and Association With Repeat Echocardiography in Nonrefractory Kawasaki Disease

Nicholas A. Clark, Troy Richardson, Jennifer E. Schuster, Anitha Parthiban and Henry T. Puls
Hospital Pediatrics January 2021, 11 (1) 36-43; DOI: https://doi.org/10.1542/hpeds.2020-0145
Nicholas A. Clark
aDivisions of Hospital Medicine,
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Troy Richardson
aDivisions of Hospital Medicine,
bChildren’s Hospital Association, Lenexa, Kansas
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Jennifer E. Schuster
cInfectious Diseases, and
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Anitha Parthiban
dCardiology, Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri; and
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Henry T. Puls
aDivisions of Hospital Medicine,
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Abstract

OBJECTIVES: Echocardiography performed under sedation allows for better coronary artery visualization in children with Kawasaki disease. We sought to describe hospital-level variability in the percentage of sedated echocardiography (SE) among children with nonrefractory Kawasaki disease (NRKD) and then test its association with repeat echocardiography, length of stay (LOS), and costs.

METHODS: We identified children in the Pediatric Health Information System <36 months of age hospitalized with NRKD from March 2010 to February 2017. Hospital-level percentage of SE was the primary outcome. Secondary outcomes were repeat echocardiography during the same hospitalization, LOS, and costs. We used χ2 and Wilcoxon rank tests to compare differences in repeat echocardiography between SE and nonsedated echocardiography. Pearson correlation was used to test associations between SE and repeat echocardiography, LOS, and costs.

RESULTS: There were 2887 NRKD hospitalizations from 40 children’s hospitals. Initial SE varied from 0.0% to 87.0% (median 5.9%; interquartile range 1.4%–21.1%). Of initial echocardiographies, 22.4% were sedated and 10.1% of all hospitalizations had a repeat echocardiography. Use of SE at the hospital level was associated with a lower likelihood for repeat echocardiography (r = −0.32; 95% confidence interval −0.58 to −0.01; P = .042). Absolute risk reduction was 3.5% and the number needed to sedate was 29. Initial SE was not associated with LOS or hospital-level costs but was associated with increased patient-level costs.

CONCLUSIONS: Significant variation exists in the use of SE for children <36 months of age with NRKD at children’s hospitals. Our results suggest that determination of SE should not be driven by concern for repeat echocardiography or LOS considerations.

  • Copyright © 2021 by the American Academy of Pediatrics
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Hospital Pediatrics: 11 (1)
Hospital Pediatrics
Vol. 11, Issue 1
1 Jan 2021
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Variations in Sedated Echocardiography and Association With Repeat Echocardiography in Nonrefractory Kawasaki Disease
Nicholas A. Clark, Troy Richardson, Jennifer E. Schuster, Anitha Parthiban, Henry T. Puls
Hospital Pediatrics Jan 2021, 11 (1) 36-43; DOI: 10.1542/hpeds.2020-0145

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Variations in Sedated Echocardiography and Association With Repeat Echocardiography in Nonrefractory Kawasaki Disease
Nicholas A. Clark, Troy Richardson, Jennifer E. Schuster, Anitha Parthiban, Henry T. Puls
Hospital Pediatrics Jan 2021, 11 (1) 36-43; DOI: 10.1542/hpeds.2020-0145
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