114 - KAWASAKI DISEASE CHANGES IN THE POST COVID MIS-C ERA IN A QUATERNARY CHILDRENS HOSPITAL

Background:

Kawasaki Disease (KD), the most common cause of acquired heart disease in the developed world, affects young children < 6 years and males more commonly.  While treatment of KD remained the same, patients with MIS-c required additional treatments, potentially leading a change in practice of initial treatment of KD.

Study Question:

Has the incidence, demographic or treatment characteristics of Kawasaki Disease changed prior to, during, and since the COVID-19 pandemic began?

Methods:

We reviewed our electronic medical record (EMR) for all new diagnoses of KD, defined as an admission with a new diagnosis of KD and receiving IVIg in the same hospitalization, between 1/1/2013 and 12/31/2022. We obtained demographic data, medications administered, and additional diagnoses from the EMR. KD incidence was calculated as new admission per 1000 hospital admissions. Chi-square and ANOVA comparisons of groups were made to determine the era effect of pre-COVID (1/13-12/19), COVID (1/20-6/21), and post-COVID (6/21-12/22) times.

Results:

During the study period 1094 children were admitted with a new KD diagnosis.  The average age was 3 years with males representing 62% of cases. Overall the number of hospital admissions remained constant while number of KD diagnoses decreased, per 1000 hospital admissions between the eras (Figure1). More children were diagnosed over 8 years of age in the post-COVID era approaching significance (p=0.08). There was no change in gender  by era. The race/ethnicity of patients diagnosed with KD annually per 1000 admissions over the study period are shown in Figure 2. Non-Hispanic white and Hispanic populations showed a decrease from the pre-COVID era to the COVID and post-COVID eras (p-value 0.007 and 0.17 respectively). Treatment of KD included IVIg, with some receiving steroids, infliximab, anakinra, cyclophosphamide, with no statistical change in the treatment of acute KD over this time.

Conclusions:
KD changed after the onset of the COVID pandemic with a lower admission incidence.  While the gender distribution remained unchanged, the age at diagnosis increased and approached significance.  Non-Hispanic white and Hispanic populations demonstrated decreased incidence over time.  Further evaluation of these trends is necessary including a larger population over time.