Improvement of newly diagnosed immune thrombocytopenia management in children by implementing revised practice guidelines

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Abstract Objectives Newly diagnosed immune thrombocytopenia is typically transient, with severe bleeding rarely occurring despite low platelet counts. In the absence of significant bleeding, observation without treatment is considered safe in children. Despite guidelines prioritizing bleeding scores over platelet counts to guide treatment decisions, this practice is not widely adopted. The safety and benefit of modifying local practices to follow these guidelines remain unclear. The objective was to describe treatment and hospitalization rates after guideline implementation and to assess the occurrence of complications and persistent immune thrombocytopenia in the POST group compared with the PRE group. Methods The new algorithm recommended treatment for patients with Buchanan score ≥3 regardless of platelet count, while the previous one suggested treatment if platelet count <10 × 109/L. We compared patient management before (PRE: January 2019–December 2020) and after (POST: January 2022–December 2023) implementation of new local guidelines in the paediatric emergency department of Hospital Sainte-Justine, Quebec. Results We included 84 patients: 34 PRE and 50 POST with comparable characteristics. In the POST period, the guideline was followed in 88% of the cases, more patients were observed without treatment (PRE 24%, POST 58% P = 0.002) and less were hospitalized at diagnosis (PRE 62%, POST 22% P = 0.0005). The effect was mainly due to a higher observation rate in patients with low bleeding score (PRE 32%, POST 84%). No intracranial bleeding, death, or increased persistent ITP rate was observed. Conclusion In sum, transitioning from platelet-based to bleeding score based guidelines was safe, reduced treatment use in the emergency department, and decreased hospitalizations.

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