On 11 May 2016 the NHS Improvement Service issued a Patient Safety Alert (this can be downloaded here – http://www.societi.org.uk/resources.html) regarding Kawasaki Disease which required immediate consideration and subsequent action by all NHS organisations receiving the Alert. The deadline for acting on the Patient Safety Alert has now passed – this was 22 June 2016.
Q1 Please can you advise what action has been taken by your Trust in response to the Patient Safety Alert on Kawasaki Disease, issued on 11 May 2016?
The Patient Safety Alert on Kawasaki Disease was brought to the attention of the Lead Clinician for Paediatric Cardiology at the Royal Surrey County Hospital NHS Foundation Trust (RSCH) at the time of publication.
On receiving this alert, the Lead Clinician for Paediatric Cardiology at the RSCH double-checked to ensure that the Trust is complying with the national best practice guidelines for managing children with Kawasaki Disease at RSCH, with which the Trust is in compliance.
All suspected new cases are treated promptly with a dose of IV immunoglobulin and commenced on aspirin therapy and all patients have an ECG and echocardiogram at diagnosis. These investigations are then repeated at two weeks after diagnosis and at six weeks after diagnosis and the patient is kept on aspirin therapy pending their six week echo.
The great majority of the Trust’s patients have been free of any coronary artery involvement at the time of their six week echo – even so, all patients are reviewed again with a repeat ECG and echo approximately 12 months after their initial diagnosis. Any children who are identified with coronary artery involvement at any stage in the above process are discussed with the Trust’s tertiary referral centre for Paediatric Cardiology, Great Ormond Street Hospital (GOSH), and are followed-up in the GOSH ‘outreach’ clinic at RSCH by a specialist Paediatric Cardiologist.
Q2 Can you confirm for your Trust, if:
a) All current and past patients with giant coronary artery aneurysms resulting from Kawasaki Disease have been identified and made aware of the Patient Safety Alert
The Trust has only had one child with coronary artery aneurysms resulting from Kawasaki Disease and that patient remains under regular long-term cardiology follow-up.
b) Current and past patients with existing or resolved coronary artery aneurysms resulting from Kawasaki Disease have all been identified and notified of the Patient Safety Alert See above response
c) You have recalled these past Kawasaki Disease patients seen in the organisation, for assessment and given Patient Specific Protocols where needed See above response
Feedback to share learning was sought from NHS bodies receiving the Alert.
Q3 Please can you advise what response your Trust, on receiving the Alert, gave? See previous responses above.
Kawasaki Disease is the leading cause of acquired coronary artery disease in children in the UK. However, approaches to treatment and management of the disease in both the acute phase and long term management vary considerably. For your Trust, please can you confirm:
Q4 Are the 2013 Kawasaki Disease Management Guidelines; Management of Kawasaki Disease; D Eleftheriou, M Levin, D Shingadia, R Tulloh, NJ Klein, PA Brogan, actively implemented within your Trust? (you can download the document here: http://www.societi.org.uk/resources.html)
Yes – please see response to Q1.
Kawasaki Disease affects a growing number of children and young people in the UK.
Q5 For your Trust, listing data sets individually, please provide, per calendar year for the period 2006 to 2016 inclusive, the following information:
Number of admissions of acute Kawasaki Disease
Month of case admission
Age of patient at diagnosis
First four items of patient postcode (partial postcode which is non-identifiable)
The Trust does not centrally collate this information. However, this data should be available centrally from the Royal College of Paediatrics & Child Health (RCPCH) Surveillance Unit, to whom known cases of Kawasaki disease are reported.