Title |
Henoch Schonlein Purpura – A 5-Year Review and Proposed Pathway
|
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Published in |
PLOS ONE, January 2012
|
DOI | 10.1371/journal.pone.0029512 |
Pubmed ID | |
Authors |
Louise Watson, Amanda R. W. Richardson, Richard C. L. Holt, Caroline A. Jones, Michael W. Beresford |
Abstract |
Henoch Schonlein Purpura (HSP) is the commonest systemic vasculitis of childhood typically presenting with a palpable purpuric rash and frequently involving the renal system. We are the first group to clinically assess, critically analyse and subsequently revise a nurse led monitoring pathway for this condition.A cohort of 102 children presenting with HSP to a secondary/tertiary level UK paediatric hospital over a five year period, were monitored using a nurse led care pathway. Using this cohort, the incidence (6.21 cases per 100,000 children per year) and natural disease course of HSP nephritis (46% initial renal inflammation; 9% subsequent renal referral; 1% renal biopsy and immunosuppression) was determined. Older patients were at higher risk of requiring a renal referral (renal referral 12.3 (8.4-13.5) years vs. normal outcome 6.0 (3.7-8.5) years; p<0.01). A normal urinalysis on day 7 had a 97% (confidence interval 90 to 99%) negative predictive value in predicting a normal renal outcome.Using this data and existing literature base, The Alder Hey Henoch Schonlein Purpura Pathway was developed, a revised pathway for the screening of poor renal outcome in HSP. This is based on a six-month monitoring period for all patients presenting with HSP, which importantly prioritises patients according to the urine findings on day 7 and thus intensively monitors those at higher risk of developing nephritis. The pathway could be easily adapted for use in different settings and resources.The introduction of a standardised pathway for the monitoring of HSP will facilitate the implementation of disease registries to further our understanding of the condition and permit future clinical trials. |
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United Kingdom | 1 | 1% |
United States | 1 | 1% |
Portugal | 1 | 1% |
Unknown | 76 | 96% |
Demographic breakdown
Readers by professional status | Count | As % |
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Student > Master | 13 | 16% |
Other | 10 | 13% |
Student > Bachelor | 10 | 13% |
Researcher | 8 | 10% |
Student > Postgraduate | 8 | 10% |
Other | 20 | 25% |
Unknown | 10 | 13% |
Readers by discipline | Count | As % |
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Medicine and Dentistry | 53 | 67% |
Agricultural and Biological Sciences | 4 | 5% |
Nursing and Health Professions | 3 | 4% |
Unspecified | 2 | 3% |
Psychology | 2 | 3% |
Other | 4 | 5% |
Unknown | 11 | 14% |