(532) Trends, Complications, and Interventions of Children With Immune Thrombocytopenia in the US

Introduction: Immune thrombocytopenia (ITP) is a common acquired bleeding disorder in the pediatric population. While some studies characterize pediatric ITP as benign, serious bleeding complications have been reported. Our study evaluated the demographics, complications, interventions, and mortality in children hospitalized with ITP.

Methods: A retrospective, serial cross-sectional analysis of the Kids’ Inpatient Database from 2006 to 2019 was performed. ITP diagnosis and complications were identified using ICD 9 and 10 codes. Neonates were excluded. The chi-square test was used to compare complications and outcomes of children with ITP and all other hospital discharges. The Mantel-Haenszel test was used for linear trend analysis.

Results: Of 23,804,205 discharges, ITP was documented in 27,514 (11.6/10,000 discharges). A bimodal age distribution was observed, with the highest prevalence seen in 1-4 years of age (28.3%) followed by adolescents (18.7%). Females were 53.2%. There was an increasing prevalence of ITP cases among hospital admissions from 2006 to 2019 with a linear trend (p < 0.001). There was no difference in the distribution of cases over the different seasons. Of the hospitalized children with ITP, 6.7% underwent bone marrow (BM) biopsy, 30.3% received intravenous immunoglobulin (IVIG) infusion, 0.5% received chemotherapy, and 6.5% required platelet transfusion. Splenectomy was performed in 2.3%, with 72.9% of the total splenectomy cases performed during an elective admission. The combined prevalence of bleeding complications in patients with ITP was 3.8%, including hematuria (1.6%), melena (1.1%), gastrointestinal bleeding (0.4%), and intracerebral hemorrhage (0.3%). No difference was seen in bacterial sepsis in hospitalized children with ITP compared with children without ITP. The mortality rate for hospitalized children with ITP was 0.4%.

Conclusions: In this cross-sectional study, the national prevalence of ITP in hospitalized children is 11.6 per 10,000 hospital discharges, with an increase in trend from 2006 to 2019 in the US. An increase in ITP hospitalization trend may be due to a decrease in non-ITP admissions. Bleeding complications are uncommon in children hospitalized with ITP. We present national trends, complications, and interventions in children hospitalized with ITP in the US.