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Using a standardised protocol was effective in reducing hospitalisation and treatment use in children with newly diagnosed immune thrombocytopenia
Author(s) -
Labrosse R,
Vincent M,
Nguyen UP,
Chartrand C,
Di Liddo L,
Pastore Y
Publication year - 2017
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.13859
Subject(s) - medicine , prednisone , immune thrombocytopenia , pediatrics , retrospective cohort study , platelet
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.