IMPORTANCE: In 2011, the American Society of Hematology (ASH) published updated guidelines for the management of childhood @entity3039 ( @entity3039 ) recommending management with observation alone when there are mild or no @entity548 symptoms, regardless of platelet count. Little is known about practice patterns of newly diagnosed @entity3039 in the United States. OBJECTIVE: To understand the impact of management recommendations on practice patterns. DESIGN, SETTING, AND @entity1 : Retrospective medical record review in the @entity1 's Hospital of Philadelphia, a large, urban, pediatric tertiary care hospital in Philadelphia, Pennsylvania. The study involved 311 pediatric @entity1 with newly diagnosed @entity3039 managed between January 1, 2007, and December 31, 2012. MAIN OUTCOMES AND MEASURES: Management type (observation alone vs pharmacotherapy) was determined via medical record review and electronic pharmacy data at diagnosis and within 6 months after diagnosis. RESULTS: Overall, 44.7% of @entity1 were managed with observation alone at diagnosis, with a significant increase from 34.9% in 2007-2010 to 49.2% in 2011 (P   <   .02) and 71.1% in 2012 (P   <   .001). Of those treated, 99% were treated with intravenous immunoglobulin. In multivariable logistic regression, younger age (odds ratio, 0.92; 95% CI, 0.87-0.99), lower platelet count (odds ratio, 0.86; 95% CI, 0.83-0.89), and earlier period (2007-2010) of diagnosis (odds ratio, 0.17; 95% CI, 0.09-0.34) were significantly associated with increased odds of pharmacologic management. During 2010-2012, 20.8% of @entity1 were also treated within 6 months after diagnosis. There was no significant difference by year or initial management type in those who received this later pharmacotherapy. Additionally, 19.6% of @entity1 had documented @entity548 symptoms beyond cutaneous bruising or @entity4125 at diagnosis. @entity932 at diagnosis was rare (0.6%). CONCLUSIONS AND RELEVANCE: We demonstrated a significant practice change in the management of newly diagnosed @entity3039 at a pediatric care tertiary care hospital in the United States surrounding revision of the ASH management guidelines for childhood @entity3039 . Our experience supports adoption of observation alone for a proportion of @entity1 with newly diagnosed childhood @entity3039 . This form of management did not lead to an increase in later treatment or an increase in delayed @entity548 symptoms.

Influence of the american society of hematology guidelines on the management of newly diagnosed childhood XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'Children', 'PARTICIPANTS'] @entity932 :: ('MESH:D020300', 'Disease') :: ['Intracranial hemorrhage'] @entity548 :: ('MESH:D006470', 'Disease') :: ['bleeding'] @entity4125 :: ('MESH:D011693', 'Disease') :: ['petechiae'] @entity3039 :: ('MESH:D016553', 'Disease') :: ['ITP', 'immune thrombocytopenia']
@entity3039 :: (MESH:D016553,Disease) :: ['immune thrombocytopenia']
