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Variation in the management of Kawasaki disease
  1. Audrey Dionne1,
  2. David Burgner2,
  3. Sarah De Ferranti1,
  4. Davinder Singh-Grewal3,
  5. Jane Newburger1,
  6. Nagib Dahdah4
  1. 1 Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
  2. 2 Department of Paediatrics, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  3. 3 Department of Rheumatology, University of Sydney, Sydney, New South Wales, Australia
  4. 4 Department of Pediatric Cardiology, University of Montreal, Montreal, Quebec, Canada
  1. Correspondence to Dr Nagib Dahdah, Pediatric Cardiology, University of Montreal, Montreal, QC H3T 1C5, Canada; nagib.dahdah.hsj{at}


Intravenous immunoglobulin (IVIG) reduces coronary aneurysms in patients with Kawasaki disease (KD), but additional management options remain challenging, with no generalisable evidence-based recommendations. We performed a survey of 724 physicians from 73 countries to assess variation in practice. IVIG was the preferred initial treatment by 659 (91%) of respondents. Criteria for adjunctive primary treatment varied considerably and definitions of IVIG resistance varied markedly by geographical continent, Human Development Index tiers and medical specialty. A second dose of IVIG was used most often for patients with coronary aneurysm non-responsive to initial treatment (572, 79%), but corticosteroids (379, 52%) and tumour necrosis factor alpha inhibitors (208, 29%) were also frequently used. Our findings highlight the need for international collaborative efforts to optimise management of patients with KD worldwide.

  • cardiology
  • Kawasaki disease
  • intravenous immunoglobulin

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  • Contributors AD conceptualised and designed the study, collected the data, interpreted the data, drafted the initial manuscript and reviewed and revised the manuscript. DB, SF, DS-G, JN and ND conceptualised and designed the study, interpreted the data and critically reviewed the manuscript for important intellectual content.

  • Funding Funding was secured from the McCance Family Foundation (JWN), the Vella Fund (JWN) and BoBeauCoeur – Fondation CHU Ste-Justine (ND). DB is supported by a National Health and Medical Research (Australia) Senior Research Fellowship.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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