Abstract 13962: Understanding Hospital-Acquired Venous Thromboembolisms in Pediatric Cardiology Patients

Abstract

Objective: This study set out to determine risk factors for hospital-acquired venous thromboembolisms (VTEs) in pediatric cardiology patients in the setting of the 2016 Solutions for Patient Safety prevention guidelines. Methods: This retrospective cohort study considered all hospitalized patients discharged between 1/1/2019 and 12/31/2020, inclusive, in an university-affiliated children’s hospital. Demographic data for all patients, including service, presence of central venous catheters, administered intravenous medications, and initial Braden QD scores were included. Hospital-acquired VTEs as defined by the National Healthcare Safety Network were included. Standard descriptive statistics were utilized. Univariate analyses were conducted using the appropriate test as appropriate based on data distribution. Regularized regression using elastic net was performed to ascertain significant risk factors with p<0.05. Results: Over the study period, 28,409 patients were included. Contemporary guidelines for VTE prevention in pediatric patients only include patients greater than 12 years of age and only prevent VTEs not related to central venous catheters. However, of the 143 hospital-acquired VTEs within the study period, 67.8% occurred in patients younger than 12 years of age and 66.0% were related to a central venous catheter. The majority (54.5%) of hospital-acquired VTEs occurred in patients on the cardiology service. In a subsequent multivariable regression analysis performed on pediatric cardiology patients, risk factors for hospital-acquired VTEs included having two or more central lines simultaneously (OR 4.46, p=0.03) and treatment with IV antidiuretics (OR 3.08, p=0.04). Total Braden QD score and Braden QD subscores were not associated with hospital-acquired VTEs. (OR 1.02, p=0.99 and OR 1.37, p=0.53, respectively). Conclusion: We found that the current prevention guidelines for hospital-acquired VTEs are not applicable to the majority of pediatric cardiology patients who develop hospital-acquired VTEs. A better understanding of risk factors for hospital-acquired VTEs is needed to inform future interventions.