title: Using a standardised protocol was effective in reducing hospitalisation and treatment use in children with newly diagnosed immune thrombocytopenia.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  Our ITP management protocol significantly reduced hospitalisation rates and length of prednisone treatment without any increase in disease complications.
authors.affiliation: Division of Allergy & Clinical Immunology, Paediatric Department, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Labrosse
authors.affiliation: Division of General Paediatrics, Paediatric Department, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Vincent
authors.affiliation: Division of General Paediatrics, Paediatric Department, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
authors.forename: U-P
authors.initials: UP
authors.lastname: Nguyen
authors.affiliation: Division of General Paediatrics, Paediatric Department, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Chartrand
authors.affiliation: Division of Emergency, Paediatric Department, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Di Liddo
authors.affiliation: Division of Haematology & Oncology, Paediatric Department, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
authors.forename: Y
authors.initials: Y
authors.lastname: Pastore
mesh_terms: D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011241:Prednisone / Q000008:administration & dosage*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D011241:Prednisone
keywords: Hospitalisation; Immune thrombocytopenia; Prednisolone treatment; Standardised protocol; Step-down approach