Multicenter Cohort Study Comparing U.S. Management of Inpatient Pediatric Immune Thrombocytopenia to Current Treatment Guidelines

Char M. Witmer, Michele P. Lambert, Sarah H. O'Brien, Cindy E Neunert

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Recent pediatric immune thrombocytopenia (ITP) guidelines have significantly altered and are encouraging an observational approach for patients without significant bleeding regardless of their platelet count. Procedure: This retrospective multicenter cohort study utilized the Pediatric Health Information Systems (PHIS) administrative database. Subjects were 6 months to 18 years of age, admitted to a PHIS hospital between January 1, 2008 and September 30, 2014, with a primary diagnosis code for ITP. International Classification of Disease, Ninth Revision, Clinical Modification Code (ICD-9-CM) discharge codes identified significant bleeding. Pharmaceutical billing codes identified the use of pharmacologic therapy for ITP. Clinical management during preguideline admissions (January 1, 2008 to August 31, 2011) was compared to postguideline admissions (September 1, 2011 to September 30, 2014). Results: A total of 4,937 subjects met inclusion criteria with a mean age of 6.2 (SD 5) years; 93.4% (4,613/4,937) received pharmacologic treatment for ITP but only 14.2% (699/4,937) had ICD-9-CM codes for significant bleeding; 11.5% (570/4,937) of subjects were readmitted. In comparing pre- versus postguideline time periods, the proportion of subjects receiving ITP pharmacologic treatment did not change (92.9% vs. 94.1%; P = 0.26). A decrease was found in the proportion of bone marrows performed (9.7% vs. 6.4%; P < 0.001) and length of stay (2.3 vs. 2 days; P < 0.001). The proportion of ITP admissions from 2012 to 2014 was modestly decreased when compared to 2008-2010 (12.9 vs. 14.5/10,000 PHIS admissions, P < 0.001). Conclusions: Despite guidelines and evidence that supports a watchful waiting approach for pediatric patients with ITP, a large proportion of inpatients without significant bleeding are still receiving pharmacologic therapy. Continued efforts are needed to address why inpatient U.S. practice patterns are so discrepant from current treatment guidelines.

Original languageEnglish (US)
Pages (from-to)1227-1231
Number of pages5
JournalPediatric Blood and Cancer
Volume63
Issue number7
DOIs
StatePublished - Jul 1 2016

Fingerprint

Idiopathic Thrombocytopenic Purpura
Multicenter Studies
Inpatients
Cohort Studies
Guidelines
Pediatrics
Health Information Systems
International Classification of Diseases
Hemorrhage
Therapeutics
Watchful Waiting
Platelet Count
Length of Stay
Bone Marrow
Databases
Pharmaceutical Preparations

Keywords

  • Immune thrombocytopenia
  • Intracranial hemorrhage
  • Management
  • Pharmacologic treatment
  • Treatment guidelines

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Multicenter Cohort Study Comparing U.S. Management of Inpatient Pediatric Immune Thrombocytopenia to Current Treatment Guidelines. / Witmer, Char M.; Lambert, Michele P.; O'Brien, Sarah H.; Neunert, Cindy E.

In: Pediatric Blood and Cancer, Vol. 63, No. 7, 01.07.2016, p. 1227-1231.

Research output: Contribution to journalArticle

Witmer, Char M. ; Lambert, Michele P. ; O'Brien, Sarah H. ; Neunert, Cindy E. / Multicenter Cohort Study Comparing U.S. Management of Inpatient Pediatric Immune Thrombocytopenia to Current Treatment Guidelines. In: Pediatric Blood and Cancer. 2016 ; Vol. 63, No. 7. pp. 1227-1231.
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