Epidemiology and Risk Assessment of Pediatric Venous Thromboembolism.

Arash Mahajerin,Stacy E Croteau

doi:10.3389/fped.2017.00068

Abstract

The incidence of diagnosed venous thromboembolism (VTE) has been increasing concurrent with advances in technology and medical care that enhance our ability to treat pediatric patients with critical illness or complex multiorgan system dysfunction. Although the overall incidence of VTE is estimated at 0.07–0.49 per 10,000 children, higher rates are observed in specific populations including hospitalized children, those with central venous catheters (CVCs) or patients convalescing from a major surgery. While the absolute number of pediatric VTE events may seem trivial compared to adults, the increasing incidence, associated with increased mortality and morbidity, the availability of novel therapies, and the impact on the cost of care have made investigation of VTE risk factors and prevention strategies a high priority. Many putative risk factors for pediatric VTE have been reported, primarily from single-institution, retrospective studies which lack appropriate methods for verifying independent risk factors. In addition, some risk factors have inconsistent definitions, which vex meta-analyses. CVCs are the most prevalent risk factors but have not consistently been assigned the highest level of risk as defined by odds ratios from retrospective, case–control studies. Few risk-assessment models for hospital-acquired pediatric VTE have been published. Some models focus exclusively on hospitalized pediatric patients, while others target specific populations such as patients with cancer or severe trauma. Multicenter, prospective studies are needed to identify and confirm risk factors in order to create a pediatric risk-assessment tool and optimize preventive measures and reduce unintended harm.

Highlights

Understanding and intervening on preventable factors that provoke venous thromboembolism (VTE) in pediatrics is a leading initiative for children’s hospitals [1]
It is likely that intensive care unit (ICU) admission or prolonged stay is a proxy for illness severity and need for additional interventions, e.g., central venous catheters (CVCs), mechanical ventilation that directly contributes to increased VTE risk
ICU, intensive care unit; MV, mechanical ventilation; LOS, length of stay; OCP, oral contraceptive pill; CVC, central venous catheters; ISS, injury severity score; BSA, body surface area. aIncluded venous and arterial thromboembolism in their study. bPresence of this factor results in point reduction from score

Summary

INTRODUCTION

Understanding and intervening on preventable factors that provoke venous thromboembolism (VTE) in pediatrics is a leading initiative for children’s hospitals [1]. One study demonstrated ICU admission confers independent VTE risk in all pediatric patients [27]. It is likely that ICU admission or prolonged stay is a proxy for illness severity and need for additional interventions, e.g., CVCs, mechanical ventilation that directly contributes to increased VTE risk. Similar to ICU admission, mechanical ventilation may be a proxy for a severely ill child In both trauma and critical care pediatric populations, mechanical ventilation has been identified as an independent VTE risk factor [36,37,38]. Branchford et al showed independent risk with mechanical ventilation, systemic infection, and hospital stay ≥5 days, and that these three factors co-occurring yielded a posttest probability of 3.1% for HA-VTE [36]. Sharathkumar et al [27] Arlikar et al Atchison et al

Literature review

Findings

CONCLUSION