Kawasaki Disease or Incomplete Kawasaki Disease Clinical Pathway — Emergency Department and Inpatient

Discharge Instructions and Follow-up Plan
Please ensure that Kawasaki disease is listed as the principal problem and select recommended discharge orders/instructions in EPIC.
Aspirin (ASA)	Low-dose ASA should be continued until directed by Cardiology. Patients with coronary abnormalities may require prolonged use of ASA. Avoid NSAIDS while on ASA.
Steroids If received Inpatient	2-3 week oral prednisolone/prednisone taper after initial treatment. Suggested taper: 2mg/kg/day div BID x 5 days, 1 mg/kg/day div BID x 5 days, 0.5 mg/kg/day DAILY x 5 days.
Outpatient Follow-up	PCP Follow up within 2-3 days. Cardiology Follow up with repeat echocardiogram in approximately two weeks. Significant coronary findings may require earlier follow-up and more frequent echocardiograms. Rheumatology Follow up in 1-2 weeks if received steroids, inpatient. All appointments should be made before discharge, if possible.
Reasons to Return to ED	Parent/caregiver should check child's temperature daily for 1-2 weeks after discharge from the hospital. If the temperature is > 38° C or if other symptoms of Kawasaki disease return before follow-up with Cardiology or Rheumatology, child should return to the ED.
Vaccines	No live vaccines x 11 months. During flu season: flu shot prior to discharge if not already received.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.