Pediatric therapeutic plasma exchange indications and patterns of use in US children's hospitals.
OBJECTIVE
Therapeutic plasma exchange (TPE) has been increasingly used over the past decade as a first-line and lifesaving treatment for various conditions classified by the American society for apheresis (ASFA). To date, the degree to which utilization of TPE in pediatrics mirrors recommendations is unknown.


METHODS
Using inpatient administrative data from 42 children's hospitals we conducted an 8-year retrospective cohort study of children (≤18 years) with an international classification of diseases-9-clinical modification (ICD-9-CM) discharge diagnosis indicating an ASFA Category I or II condition, or a procedure code indicating receipt of TPE during hospitalization.


RESULTS
TPE was performed during 4,190 hospitalizations of 3,449 patients, of whom 310 (9.0%) and 77 (2.2%) had a primary discharge diagnosis of an ASFA Category I or II condition, respectively. Rates of TPE use for Category I conditions were highest for children with thrombotic thrombocytopenic purpura (TTP), Goodpasture's syndrome, and myasthenia gravis. TPE use in children's hospitals significantly increased from 2003 to 2010, but TPE was performed during only 13.4 and 9.3% of hospitalizations for ASFA Category I and II conditions, respectively. There was significant between-hospital variation in the use of TPE for Category I conditions as a group and individual Category I conditions including TTP.


CONCLUSIONS
We found low levels of TPE use across hospitals for key indications, including TTP, a condition for which TPE is considered a first-line and life-saving procedure. The variation identified may contribute to varying clinical outcomes between hospitals, warrants further investigation, and represents an important opportunity to improve quality of care.
Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. weisspa@email.chop.edu
Pamela F
PF
Weiss
Andrew J
AJ
Klink
David F
DF
Friedman
Chris
C
Feudtner
D058186:Acute Kidney Injury / Q000628:therapy; D000293:Adolescent; D019867:Anti-Glomerular Basement Membrane Disease / Q000628:therapy; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000628:therapy; D001327:Autoimmune Diseases / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003953:Diagnosis-Related Groups; D004660:Encephalitis / Q000628:therapy; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D038801:International Classification of Diseases; D008297:Male; D009157:Myasthenia Gravis / Q000628:therapy; D010951:Plasma Exchange / Q000706:statistics & numerical data* / Q000639:trends; D011697:Purpura, Thrombotic Thrombocytopenic / Q000628:therapy; D044469:Racial Groups; D012131:Respiratory Insufficiency / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States