Children still hospitalized and treated for ITP despite conservative guidelines

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1. Most hospitalized children with newly diagnosed immune thrombocytopenia (ITP) were given pharmacological therapy, with intravenous immunoglobulin (IVIG) being the most common. 

2. Management of newly diagnosed ITP differed by geographic location in US children’s hospitals. 

Study Rundown: Recent evidence-based guidelines for the management of ITP, an autoimmune disease characterized by increased bleeding risk, suggest conservative, observation-based care. This study evaluated 2314 pediatric patients with newly diagnosed ITP at freestanding US children’s hospitals to examine current practices in the context of the new guidelines. Using data from the Pediatric Health Information System (PHIS), a large database from 43 US children’s hospitals, it was determined that many hospitalized patients were given pharmacological therapy. IVIG was the most commonly used therapy, despite being the most expensive. A small portion of patients had noncutaneous bleeding and few experienced the most concerning ITP-related complication, intracranial hemorrhage. Significant differences in approach and costs were observed between freestanding US children’s hospitals. Limitations to the study included a lack of comparison to patients managed in an outpatient setting, which would better elucidate reasons for hospitalization. Findings suggest further evaluation of national practices to better align with recent guidelines recommending conservative, observation-based care over broad pharmacological therapy.

Click to read the study, published today in Pediatrics

In-depth [retrospective analysis]: The study examined the management of 2314 pediatric patients with newly diagnosed ITP at freestanding US children’s hospitals through the PHIS database. 90% of hospitalized patients were medically treated, with 78% receiving IVIG compared to anti-D immunoglobulin and corticosteroid treatments. Noncutaneous bleeding occurred in 12% of cases with epistaxis being the most common manifestation in 7.8% of patients. Intracranial bleeding was observed in only 0.6% of cases. Mortality rate was 0.1% in admitted patients. Significant regional differences in approach and costs were observed amongst freestanding US children’s hospitals with IVIG use ranging from 66.2%-85.0% and total hospital charges ranging from $7194-11409. 

By Neha Joshi and Leah H. Carr

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