Self-reported diagnostic and management strategies in childhood XXXX : results of a survey of practicing pediatric hematology/oncology specialists.

@entity1 @entity548 @entity2133 @entity229 @entity4125 @entity230 @entity3039 @entity288
PURPOSE: To assess current physician self-reported practices regarding initial management of childhood @entity3039 ( @entity3039 ) and to determine physician self-reported willingness to participate in randomized clinical trials comparing different initial management strategies. @entity1 AND METHODS: A questionnaire was mailed in November 1997 to all 720 members of the American Society of Pediatric Hematology/Oncology asking how they would diagnose and manage @entity3039 in @entity1 18 months, 5 years, and 15 years of age who were experiencing either @entity2133 (cutaneous @entity548 only) or wet @entity4125 ( @entity548 ). Specific questions dealt with bone marrow aspiration, hospital admittance, treatment strategy, and specific doses of corticosteroids and intravenous immunoglobulin. RESULTS: The response rate to the questionnaire was 57%. Most respondents indicated they usually perform a bone marrow aspirate when @entity288 are to be prescribed and administer drug therapy to @entity1 with newly diagnosed @entity3039 with wet or @entity2133 . Only 16% of respondents would administer no drug therapy to a @entity1 with @entity2133 . Intravenous immunoglobulin (IVIG) was preferred to @entity230 , with anti-D immunoglobulin prescribed less frequently. Hospital admittance often was used for @entity1 with @entity2133 and usually recommended for @entity1 with wet @entity4125 . Most respondents expressed willingness to randomize @entity1 with @entity2133 to IVIG versus no therapy and those with wet @entity4125 to IVIG versus @entity229 as part of a randomized controlled clinical trial. CONCLUSIONS: The self-reported care of the @entity1 with @entity3039 was influenced by the severity of presentation (dry versus wet @entity4125 ). Most physicians reported they would administer specific drug treatment in both scenarios. This survey illustrates the diverse diagnostic and management strategies currently used in childhood @entity3039 . Because no one therapeutic approach is predominant and a scientific basis for decision making in childhood @entity3039 has not been developed, future randomized trials are warranted. On the basis of these survey results, such trials are desired by most pediatric hematology/oncology specialists.
