Using a standardised protocol was effective in reducing hospitalisation and treatment use in children with newly diagnosed immune thrombocytopenia. (11th May 2017)

• Record Type: Journal Article
• Authors: Labrosse, R; Vincent, M; Nguyen, U‐P; Chartrand, C; Di Liddo, L; Pastore, Y
• Is Part Of: Acta pædiatrica. Volume 106:Number 10(2017)
• Page Start: 1617
• Page End: 1623
• Publication Date: 2017-05-11
• Subjects: Hospitalisation -- Immune thrombocytopenia -- Prednisolone treatment -- Standardised protocol -- Step‐down approach; Pediatrics -- Periodicals; Pediatrics; 618.92
• DOI: 10.1111/apa.13859
• Languages: English
• ISSNs: 0803-5253

Abstract

Abstract: Aim: Childhood immune thrombocytopenia (ITP) has been associated with low bleeding rates and a high frequency of spontaneous remission. Although current guidelines suggest that most patients are just observed, children still receive platelet‐enhancing therapies for fear of bleeding complications. We hypothesised that a standardised protocol with a step‐down approach would reduce hospitalisation and treatment use. Method: A retrospective chart review was performed on patients diagnosed with acute ITP between January 2010 and December 2014, before (n = 54) and after (n = 37) the standardised protocol, which was introduced in January 2013. Management and events during the first 3 months following diagnosis were recorded. Results: The protocol resulted in a 34% decrease in the hospitalisation rate (p < 0.001) at diagnosis. Prednisone treatment duration at diagnosis was also significantly reduced (13.1 versus 5.8 days, p = 0.004). Children over 3 years of age were 3.8 times less likely to be hospitalised (95% CI 1.94–7.61) and 2.3 times less likely to receive treatment (95% CI 1.2–4.3). There was no difference in the rate of persistent ITP (38% versus 30%, p = 0.43) or serious bleeding complications (7% versus 5%, p = 0.70). Conclusion: Our ITP management protocol significantly reduced hospitalisation rates and length of prednisone treatment without any increase in disease complications. Abstract :