Pediatric therapeutic plasma exchange indications and patterns of use in US children's hospitals.

TitlePediatric therapeutic plasma exchange indications and patterns of use in US children's hospitals.
Publication TypeJournal Article
Year of Publication2012
AuthorsWeiss PF, Klink AJ, Friedman DF, Feudtner C
JournalJ Clin Apher
Date Published2012 Jul
KeywordsAcute Kidney Injury, Adolescent, Anti-Glomerular Basement Membrane Disease, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis, Autoimmune Diseases, Child, Child, Preschool, Continental Population Groups, Diagnosis-Related Groups, Encephalitis, Female, Hospitals, Pediatric, Humans, Infant, International Classification of Diseases, Male, Myasthenia Gravis, Plasma Exchange, Purpura, Thrombotic Thrombocytopenic, Respiratory Insufficiency, Retrospective Studies, Treatment Outcome, United States

PURPOSE: Therapeutic plasma exchange (TPE) has been increasingly used over the past decade as a first-line and lifesaving treatment for various conditions classified by the American society for apheresis (ASFA). To date, the degree to which utilization of TPE in pediatrics mirrors recommendations is unknown.

METHODS: Using inpatient administrative data from 42 children's hospitals we conducted an 8-year retrospective cohort study of children (≤18 years) with an international classification of diseases-9-clinical modification (ICD-9-CM) discharge diagnosis indicating an ASFA Category I or II condition, or a procedure code indicating receipt of TPE during hospitalization.

RESULTS: TPE was performed during 4,190 hospitalizations of 3,449 patients, of whom 310 (9.0%) and 77 (2.2%) had a primary discharge diagnosis of an ASFA Category I or II condition, respectively. Rates of TPE use for Category I conditions were highest for children with thrombotic thrombocytopenic purpura (TTP), Goodpasture's syndrome, and myasthenia gravis. TPE use in children's hospitals significantly increased from 2003 to 2010, but TPE was performed during only 13.4 and 9.3% of hospitalizations for ASFA Category I and II conditions, respectively. There was significant between-hospital variation in the use of TPE for Category I conditions as a group and individual Category I conditions including TTP.

CONCLUSION: We found low levels of TPE use across hospitals for key indications, including TTP, a condition for which TPE is considered a first-line and life-saving procedure. The variation identified may contribute to varying clinical outcomes between hospitals, warrants further investigation, and represents an important opportunity to improve quality of care.

Alternate JournalJ Clin Apher
PubMed ID22811262