Identification of a “VTE-rich” population in pediatrics – Critically ill children with central venous catheters

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BackgroundThe incidence of venous thromboembolism (VTE) is rising among inpatients in US hospitals, especially among kids with central venous catheters (CVCs) in the pediatric intensive care unit (PICU). ObjectivesTo identify a sub-group of “VTE-rich” population among PICU children, and to assess the effect of VTE on morbidity and mortality. MethodsData was extracted from a multicenter Virtual PICU Database, or VPS, for children with a CVC and presence of a VTE. The primary outcome variable was all cause mortality and secondary outcome measure was prolonged mechanical ventilation. Primary diagnoses and Pediatric risk of mortality 2 (PIM 2) score were also recorded. ResultsThe database identified 158,299 PICU patients who had a CVC. A total of 1602 patients had VTE (103 per 10,000 PICU patients). Multivariate analysis showed increased risk of VTE in patients who were <1year old (OR 1.48; 1.30–1.68), mechanically ventilated (OR 2.48; 2.07–2.98), had either a diagnostic (OR 2.32; 1.94–2.78) or therapeutic cardiac catheterization (OR 2.06; 1.66–2.55), PICC (OR 3.91; 3.50–4.37), and percutaneous CVC (OR 3.99; 3.48–4.61). Primary diagnoses associated with VTE were endocrinologic, immunologic, and gastrointestinal disorders. PICU patients with CVC and VTE had increased odds of mortality (OR 1.71; 1.47–2.00) after adjusting for factors associated with mortality, and fewer Ventilator Free Days (VFD) than patients without VTE. ConclusionsCritically ill children with CVC have a significant risk of developing VTE. Identification of the above “VTE-rich” population may aid in design of clinical trials aimed at prevention of VTE among hospitalized PICU children.