144: How do we Treat Acute Immune Thrombocytopoenia (ITP) in the Maritime Provinces?
Bibliographic record
Abstract
The diagnosis and management of immune thrombocytopoenia (ITP) of childhood is controversial amongst paediatricians. ITP is the most common bleeding disorder of childhood and is characterized by an isolated low platelet count (<100×109/L). The disorder is usually self-limiting – nearly 80% of childhood ITP spontaneously resolve within a year. However, many patients receive therapy to avoid the rare incidence of clinically significant bleeding. Published guidelines have differed in recommendations for diagnosis and management. This study aimed to explore approaches in managing acute ITP at the IWK Health Centre and across the Maritimes Provinces. A literature review, retrospective chart review of ITP patients followed at the IWK since January 1, 1990, and an online survey of paediatricians' practices were conducted. Published guidelines are converging and encourage paediatricians to treat based on symptoms not absolute platelet counts. Chart review showed that 99 of 144 patients received at least one course of treatment – 60 of 99 with IVIg and 37 of 99 with corticosteroids. The decision to treat 66 of 99 was on platelet count alone. Bone marrow examinations, recommended in an atypical presentation or prolonged course of disease, were performed in 54 patients. IWK paediatricians relied on clinical experience in 135 cases and consultation with colleagues in 36 cases. Twenty-four Maritime paediatricians who responded to our online questionnaire manage ITP. 17completed the survey. Nineteen of 24 were uncertain of recommended diagnostic platelet counts for ITP. Two of 24 reported using published resources to complete the survey. Thirteen of 21 paediatricians reported they would use published guidelines to guide management in provided case scenarios and 17 of 21 would consult colleagues. Actual management of acute ITP differs from published guidelines: patients are treated more for platelet counts and may be over-investigated and over-treated. Lack of adequate documentation may bias results. Maritime paediatricians prefer managing patients collaboratively, suggesting that further education would benefit practice. A prospective pan-Canada survey would explore this further.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".