Del Vecchio Giovanni Carlo, De Santis Attilio, Giordano Paola, Amendola Giovanni, Baronci Carlo, Del Principe Domenico, Nobili Bruno, Jankovic Momcilo, Ramenghi Ugo, Russo Giovanna, Zecca Marco, De Mattia Domenico
Dipartimento di Biomedicina dell'Età Evolutiva, Università di Bari, Bari, Italia.
Acta Haematol. 2008;119(1):1-7. doi: 10.1159/000112837. Epub 2008 Jan 4.
Consensus guidelines for diagnosis and treatment of acute childhood idiopathic thrombocytopenic purpura (ITP) were published in 2000 by the Italian Association of Pediatric Haematology and Oncology (AIEOP). The assessment of guideline implementation was the primary objective of the present study.
Information on each newly diagnosed case of ITP referring to centres conforming with the guidelines was obtained by a questionnaire.
Data concerning 609 new cases of acute childhood ITP were collected including 346 (56.8%) asymptomatic-paucisymptomatic forms (type A), 262 (43%) intermediate clinical forms (type B), and 1 (0.2%) severe form (type C). At diagnosis, 82% of cases were hospitalized. Age, platelet count and duration of hospitalization were significantly different in type A and type B cases. Of the total number of cases, 25% were kept under observation, 38.6% received intravenous immunoglobulins, 23.9% oral or parenteral steroids, and 12.7% other treatments. The initial treatment turned out to be appropriate for 428 cases (72.2%), of uncertain appropriateness in 71 (11.9%), and inappropriate in 95 cases (15.9%). The total level of implementation was 84.1%.
A high rate of guideline implementation was observed during the study period. The guidelines should be reviewed taking into account more recent evidence.
意大利儿童血液学和肿瘤学协会（AIEOP）于2000年发布了儿童急性特发性血小板减少性紫癜（ITP）诊断和治疗的共识指南。本研究的主要目的是评估该指南的实施情况。
通过问卷调查获取了符合指南的各中心新诊断ITP病例的信息。
收集了609例儿童急性ITP新病例的数据，其中包括346例（56.8%）无症状-少症状型（A型）、262例（43%）中度临床型（B型）和1例（0.2%）重度型（C型）。诊断时，82%的病例住院治疗。A型和B型病例在年龄、血小板计数和住院时间方面存在显著差异。在所有病例中，25%接受观察，38.6%接受静脉注射免疫球蛋白治疗，23.9%接受口服或胃肠外类固醇治疗，12.7%接受其他治疗。结果显示，428例（72.2%）的初始治疗是合适的，71例（11.9%）的合适性不确定，95例（15.9%）的治疗不合适。总体实施水平为84.1%。
在研究期间观察到指南实施率较高。应结合最新证据对指南进行审查。
