Hospitalizations in pediatric patients with immune thrombocytopenia in the United States

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为探究小儿免疫性血小板减少症（pediatric immune thrombocytopenia, ITP）住院患者的诊疗利用情况与临床转归，我们采用国际疾病分类第9版（ICD-9）编码287.31，从2009年美国医疗成本和利用项目儿童住院数据库（HCUP KID）中识别出罹患ITP的儿科住院病例——该数据库为覆盖美国社区医院的全支付者儿科住院病例样本。 研究人员通过诊断与操作编码，估算了ITP相关操作的开展率、合并症患病率、住院费用、住院时长（LOS）及死亡率。 2009年，6个月至17岁的ITP患儿共计约4499例次住院；其中1~5岁患儿占比43%，伴有急诊就诊的病例占47%。 整体队列的平均住院费用为5398美元，平均住院时长为2.0天，总死亡率为0.3%（共13例死亡病例）。 合并任何类型出血的病例（占比15.2%，其中胃肠道出血2.0%、血尿1.3%、颅内出血[ICH]0.6%），平均住院费用为7215美元，平均住院时长为2.5天，死亡率为1.5%。 其中仅合并颅内出血（ICH）的病例（占比0.6%，共27例），平均住院费用为40209美元，平均住院时长为8.5天，死亡率高达21%。 合并感染的病例（占比14.0%，其中上呼吸道感染5.2%、病毒感染4.9%、细菌感染1.9%），平均住院费用为6928美元，平均住院时长为2.9天，死亡率为0.9%。 另有0.3%的出院病例报告存在感染性休克。 诊疗利用情况方面，免疫球蛋白输注占比37%，脾切除术占比2.3%。 与更高住院费用相关的因素包括年龄＞6岁、ICH、血尿、输血、脾切除术及骨髓检查（p