title: Patterns of inpatient care for newly diagnosed immune thrombocytopenia in US children's hospitals.
abstract: OBJECTIVE
  Although recent evidence-based guidelines for the management of immune thrombocytopenia (ITP) recommend a conservative, observation-based approach for the majority of patients with newly diagnosed pediatric ITP, current practice patterns are unknown. This study used the Pediatric Health Information System database to examine patterns of inpatient care in newly diagnosed ITP in freestanding US children's hospitals and to examine geographic differences in care.
  
  
  METHODS
  Data were extracted from Pediatric Health Information System for all newly diagnosed ITP admissions aged 1 to 18 years discharged between January 2008 and December 2010. Clinical data obtained included age, gender, length of stay, diagnoses, medications, and discharge status.
  
  
  RESULTS
  We identified 2314 unique patients meeting the study diagnosis of newly diagnosed ITP. Noncutaneous bleeding occurred in 12% of patients (intracranial hemorrhage 0.6%), with epistaxis the most commonly reported symptom. Ninety percent of hospitalized patients received ITP-directed therapy, with intravenous immunoglobulin G the most commonly used therapy (78% of patients). We identified significant variation by geographic region in treatment strategies, length of stay, hospital charges, and likelihood of readmission.
  
  
  CONCLUSIONS
  A substantial number of children with newly diagnosed ITP continue to be hospitalized and receive intravenous medications, although the majority of these patients do not have clinical bleeding events during the admission. By using these results as a backdrop, future studies will be able to identify if the number of ITP admissions, costs of care, and geographic variability in care decrease with the dissemination and implementation of recently published guidelines.
authors.affiliation: College of Medicine, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Kime
authors.forename: Jennifer
authors.initials: J
authors.lastname: Klima
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Rose
authors.forename: Sarah H
authors.initials: SH
authors.lastname: O'Brien
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D017052:Hospital Mortality / Q000639:trends; D006776:Hospitals, Pediatric / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000191:economics / Q000627:therapeutic use; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics / Q000639:trends*; D008297:Male; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D005791:Patient Care / Q000379:methods / Q000639:trends*; D010351:Patient Discharge / Q000706:statistics & numerical data / Q000639:trends; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
chemical_list: D016756:Immunoglobulins, Intravenous
keywords: ITP; epidemiology; pediatric