Patterns of Inpatient Care for Newly Diagnosed Immune Thrombocytopenia in US Children’s Hospitals

TLDR

Current practice patterns for newly diagnosed pediatric ITP are unknown despite guidelines recommending a conservative, observation-based approach. The study examined inpatient care patterns and geographic variation in newly diagnosed pediatric ITP admissions to inform future evaluations of guideline implementation. The authors performed a retrospective cohort study using the Pediatric Health Information System database, extracting demographic and clinical data for 2,314 newly diagnosed ITP admissions between 2008 and 2010. Among 2,314 admissions, 12% had noncutaneous bleeding (0.6% intracranial), 90% received ITP-directed therapy—primarily IVIG (78%)—and there was marked geographic variation in treatment, length of stay, costs, and readmission rates, with most hospitalized patients receiving IV therapy despite minimal bleeding.

Abstract

Although recent evidence-based guidelines for the management of immune thrombocytopenia (ITP) recommend a conservative, observation-based approach for the majority of patients with newly diagnosed pediatric ITP, current practice patterns are unknown. This study used the Pediatric Health Information System database to examine patterns of inpatient care in newly diagnosed ITP in freestanding US children's hospitals and to examine geographic differences in care.Data were extracted from Pediatric Health Information System for all newly diagnosed ITP admissions aged 1 to 18 years discharged between January 2008 and December 2010. Clinical data obtained included age, gender, length of stay, diagnoses, medications, and discharge status.We identified 2314 unique patients meeting the study diagnosis of newly diagnosed ITP. Noncutaneous bleeding occurred in 12% of patients (intracranial hemorrhage 0.6%), with epistaxis the most commonly reported symptom. Ninety percent of hospitalized patients received ITP-directed therapy, with intravenous immunoglobulin G the most commonly used therapy (78% of patients). We identified significant variation by geographic region in treatment strategies, length of stay, hospital charges, and likelihood of readmission.A substantial number of children with newly diagnosed ITP continue to be hospitalized and receive intravenous medications, although the majority of these patients do not have clinical bleeding events during the admission. By using these results as a backdrop, future studies will be able to identify if the number of ITP admissions, costs of care, and geographic variability in care decrease with the dissemination and implementation of recently published guidelines.