Trends in the Diagnosis of Pediatric Venous Thromboembolism and Arterial Ischemic Stroke during the COVID-19 Pandemic: An Administrative Database Study

Abstract

To investigate recent trends in the diagnosis of venous thromboembolism (VTE) and ischemic stroke (AIS), and examine the use of pharmacological thromboprophylaxis during the COVID-19 pandemic. This retrospective-cohort study used the Pediatric Health Information Systems (PHIS) database to investigate patients admitted to a participating hospital between January 1, 2018, and December 31, 2021. ICD-10 codes were used to identify VTE, AIS, and COVID-19. Pharmacy billing codes were used to investigate pharmacological thromboprophylaxis use. 1,759,701 unique patients underwent 2,234,135 inpatient admissions. Rate of VTE increased from 84 cases per 10,000 admissions in 2018-2019 to 108 cases per 10,000 admissions in 2020-2021, representing a 28.6% increase (p<0.001). In contrast, the rate of AIS remained stable through the study period. When compared with 2018-2019, children diagnosed with VTE during 2020-2021 had longer hospitalizations and were more likely to be admitted to the intensive care unit. When analysis was limited to 2020-2021, a diagnosis code of COVID-19 was associated with a 1.35-fold (95%CI: 1.24-1.45) increase in the odds of VTE diagnosis, but not AIS. Use of pharmacologic thromboprophylaxis increased from 1.5% of hospitalizations in 2018-2019 to 3.0% of hospitalizations in 2020-2021 (p<0.001). When evaluating thromboprophylaxis during 2020-2021, a diagnosis code for COVID-19 was associated with an 11-fold (95% CI: 10.86-11.49; p<0.001) increase in the utilization of pharmacological thromboprophylaxis. This study found an increase in the rate of VTE among hospitalized children during the pandemic. A diagnosis of COVID-19 was associated with a modest increase in odds of VTE diagnosis, which occurred despite increased use of pharmacological thromboprophylaxis.