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.