Risk of Thromboembolism in Hospitalized Children

Abstract

Research Article| January 01 2013 Risk of Thromboembolism in Hospitalized Children AAP Grand Rounds (2013) 29 (1): 8. https://doi.org/10.1542/gr.29-1-8 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Risk of Thromboembolism in Hospitalized Children. AAP Grand Rounds January 2013; 29 (1): 8. https://doi.org/10.1542/gr.29-1-8 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: child, hospitalized, thromboembolism, venous thromboembolism, chronic disease Kerli BA, Setty BA, O'Brien SH. Pediatric venous thromboembolism in the United States: a tertiary care complication of chronic diseases. Pediatr Blood Cancer. 2012; 59(2): 258-264; doi: https://doi.org/10.1002/pbc.23388Google Scholar Investigators from Nationwide Children's Hospital in Columbus, Ohio conducted a retrospective cohort study using data from the 2006 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) from the Agency for Healthcare Research and Quality (AHRQ) to identify risk factors for venous thromboembolism (VTE) in hospitalized pediatric patients. The KID 2006 includes inpatient data on children ≤20 years old hospitalized in 38 states. The investigators used the database to identify children ≤18 years old with in-hospital VTE (deep venous thrombosis and pulmonary embolism) based on the presence of thrombosis-specific ICD-9-CM diagnosis or procedure codes. ICD- 9-CM codes were also used to categorize patients as having either an acute or chronic condition. For the analyses, discharges were grouped by age of the child (<1, 1-4, 5-9, 10-14, and 15-18 years) and hospitals were classified as children's hospitals (tertiary) or community hospitals. The relative risks (RRs) of VTE in adolescents (15-18 years old) and infants (<1 year old) were compared to the reference age group (1-4 years old). Similarly, the RRs by hospital type and by underlying condition were assessed. There were 4,538 diagnoses of VTE among the 2,410,351 eligible patient discharges included in the analyses. Of the children with VTE, 67.6% were discharged from children's hospitals (RR = 5.09 compared to those hospitalized at community hospitals). Infants (23.1%) and adolescents (37.8%) accounted for most VTE discharges. However, when standardized for the number of discharges in each age category, infants were significantly less likely to suffer VTE than older patients (RR = 0.48; 95% CI, 0.43-0.52), while adolescents were at highest risk (RR = 1.89; 95% CI, 1.73-2.07). Most children (76%) with VTE had underlying chronic illness, with cardiovascular (18.4%), malignancy (15.7%), and neuromuscular disease (9.9%) being the most common chronic conditions. The most common etiologies for VTE in patients with acute illnesses were idiopathic (12.6%) or related to infection (9.5%) and trauma (9.1%). Pediatric patients with hospitalizations ending with death were more likely to suffer VTE than those who survived the hospitalization (RR = 6.16; 95% CI, 5.32-7.13). The investigators conclude that pediatric VTE is seen mostly in tertiary care centers, with adolescents and those patients whose hospitalizations end with death at greater risk of developing VTE. There is a growing body of literature regarding pediatric VTE, yet relatively little is known regarding its true incidence, implications, and best management strategies. Like other rare clinical problems in pediatrics, management of VTE has evolved based on adult data. Pediatric VTE is thought to be multifactorial and is seen mostly in children with underlying conditions and associated with predisposing risk factors, such as indwelling venous catheters, surgery, trauma, malignancy, inherited thrombophilia, and hospitalizations >5 days.1 Boulet et al analyzed hospital discharge data and found that the risk of pediatric... You do not currently have access to this content.