title: Hospitalizations in pediatric patients with immune thrombocytopenia in the United States.
abstract: To examine utilization and outcomes in pediatric immune thrombocytopenia (ITP) hospitalizations, we used ICD-9 code 287.31 to identify hospitalizations in patients with ITP in the 2009 HCUP KID, an all-payer sample of pediatric hospitalizations from US community hospitals. Diagnosis and procedure codes were used to estimate rates of ITP-related procedures, comorbidity prevalence, costs, length of stay (LOS), and mortality. In 2009, there were an estimated 4499 hospitalizations in children aged 6 months-17 years with ITP; 43% in children aged 1-5 years; and 47% with emergency department encounters. The mean hospitalization cost was $5398, mean LOS 2.0 days, with 0.3% mortality (n = 13). With any bleeding (15.2%, including gastrointestinal 2.0%, hematuria 1.3%, intracranial hemorrhage [ICH] 0.6%), mean hospitalization cost was $7215, LOS 2.5 days, with 1.5% mortality. For ICH (0.6%, n = 27), mean cost was $40 209, LOS 8.5 days, with 21% mortality. With infections (14%, including upper respiratory 5.2%, viral 4.9%, bacterial 1.9%), the mean cost was $6928, LOS 2.9 days, with 0.9% mortality. Septic shock was reported in 0.3% of discharges. Utilization included immunoglobulin administration (37%) and splenectomies (2.3%). Factors associated with higher costs included age >6 years, ICH, hematuria, transfusion, splenectomy, and bone marrow diagnostics (p < 0.05). In conclusion, of the 4499 hospitalizations with ITP, mortality rates of 1.5%, 21%, and 0.9% were seen with any bleeding, ICH, and infection, respectively. Higher costs were associated with clinically significant bleeding and procedures. Future analyses may reveal effects of the implementation of more recent ITP guidelines and use of additional treatments.
authors.affiliation: a The Bleeding and Clotting Disorders Institute , Professor of Pediatrics and Medicine, University of Illinois College of Medicine , Peoria , IL , USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Tarantino
authors.affiliation: b Outcomes Insights, Inc. , Westlake Village , CA , USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Danese
authors.affiliation: c Department of Pediatrics , Children's Hospital of Eastern Ontario , Ottawa , Canada.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Klaassen
authors.affiliation: b Outcomes Insights, Inc. , Westlake Village , CA , USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Duryea
authors.affiliation: d Amgen Inc. , Oncology Therapeutic Area, Thousand Oaks , CA , USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Eisen
authors.affiliation: e Pediatrics and Pediatrics in Obstetrics and Gynecology and in Medicine, Weill Cornell Medicine , New York , NY , USA.
authors.forename: James
authors.initials: J
authors.lastname: Bussel
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018803:Models, Economic; D009026:Mortality; D011159:Population Surveillance; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology
keywords: Bleeding; KID; costs; infection; inpatient utilization; outcomes