Donato et al used a score to predict prognosis for a pediatric patient with idiopathic thrombocytopenic purpura (ITP). This is a modification of the score of Edslev et al. The authors are from multiple institutions in Argentina.
Patient selection: child with idiopathic thrombocytopenic purpura (ITP) < 15 years
Difference from the score of Edslev et al: platelet count raised to 10 * 10^9/L
Parameters:
(1) abrupt onset (symptoms for < 14 days)
(2) age in years
(3) antecedent preceding infection (API; viral infection or immunization <= 4 weeks prior to onset of ITP)
(4) platelet count in 10^9/L
(5) wet purpura
(6) sex
|
Parameter
|
Finding
|
Points
|
|
abrupt onset
|
no
|
0
|
|
|
yes
|
5
|
|
age in years
|
< 10 years
|
3
|
|
|
>= 10 years
|
0
|
|
antecedent preceding infection
|
no
|
0
|
|
|
yes
|
2
|
|
platelet count
|
>= 10 * 10^9/L
|
0
|
|
|
< 10 * 10^9/L
|
2
|
|
wet purpura
|
no
|
0
|
|
|
yes
|
1
|
|
sex
|
boy
|
1
|
|
|
girl
|
0
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 14
• The higher the score the better for the patient.
|
Score
|
Chances Favorable
|
Duration < 6 Months
|
|
0 to 4
|
low
|
38%
|
|
5 to 9
|
intermediate
|
66%
|
|
10 to 14
|
high
|
84%
|
Clinical observations:
(1) peak incidence occurred in children < 2 years of age, especially in males
(2) age < 1 year was associated with short duration of ITP and very high recovery rate
(3) for age >= 1 year, a low platelet count and acute preceding infection were favorable prognostic factors
(4) for those with persistent ITP, spontaneous recovery can occur between 6-12 months, so chronic ITP should be defined as > 12 months
