Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Pediatr. 2009 Dec;155(6):812-818.e1. doi: 10.1016/j.jpeds.2009.05.030. Epub 2009 Jul 29.
To describe variation regarding inpatient therapy and evaluation of children with Henoch Schönlein purpura (HSP) admitted to children's hospitals across the United States.
We conducted a retrospective cohort study of children discharged with a diagnosis of HSP between 2000 and 2007 by use of inpatient administrative data from 36 children's hospitals. We examined variation among hospitals in the use of medications, diagnostic tests, and intensive care services with multivariate mixed effects logistic regression models.
During the initial HSP hospitalization (n = 1988), corticosteroids were the most common medication (56% of cases), followed by opioids (36%), nonsteroidal antiinflammatory drugs (35%), and antihypertensive drugs (11%). After adjustment for patient characteristics, hospitals varied significantly in their use of corticosteroids, opioids, and nonsteroidal antiinflammatory drugs; the use of diagnostic abdominal imaging, endoscopy, laboratory testing, and renal biopsy; and the use of intensive care services. By contrast, hospitals did not differ significantly regarding administration of antihypertensive drugs or performance of skin biopsy.
The significant variation identified may contribute to varying HSP clinical outcomes between hospitals, warrants further investigation, and represents a potentially important opportunity to improve quality of care.
描述美国儿童医院收治的过敏性紫癜（HSP）患儿住院治疗和评估的差异。
我们对 2000 年至 2007 年期间通过 36 家儿童医院的住院管理数据出院诊断为 HSP 的儿童进行了回顾性队列研究。我们使用多变量混合效应逻辑回归模型，检查了医院之间在药物、诊断性检查和重症监护服务使用方面的差异。
在 HSP 初始住院治疗期间（n=1988），最常用的药物是皮质类固醇（56%的病例），其次是阿片类药物（36%）、非甾体抗炎药（35%）和抗高血压药物（11%）。在调整了患者特征后，医院在皮质类固醇、阿片类药物和非甾体抗炎药的使用、诊断性腹部成像、内窥镜检查、实验室检查和肾活检以及重症监护服务的使用方面存在显著差异。相比之下，医院在使用抗高血压药物或进行皮肤活检方面没有显著差异。
所确定的显著差异可能导致医院之间 HSP 临床结局的差异，值得进一步研究，并且代表了改善护理质量的一个潜在重要机会。
