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Risk factors for venous thromboembolism in pediatric trauma
Monica S Vavilala1, Avery B Nathens, Gregory J Jurkovich
1Department of Anesthesiology, University of Washington, Harborview Injury Prevention and Research Center, Seattle, Washington 98104, USA. vavilala@u.washington.edu
Insights
Pediatric venous thromboembolism (VTE) risk increases with age and injury severity. Identifying risk factors like venous catheters and specific injuries aids in preventing VTE in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Hematology
Background:
- Venous thromboembolism (VTE) is a significant cause of illness in critically ill trauma patients.
- Existing research on VTE incidence and risk factors primarily focuses on adult trauma populations.
- Data on VTE in pediatric trauma patients remain limited.
Purpose of the Study:
- To identify the incidence and risk factors associated with VTE in pediatric trauma patients.
- To provide data that can inform screening and prophylaxis strategies for VTE in injured children.
Main Methods:
- Utilized a large administrative database from 19 US states.
- Included pediatric patients (under 16 years) diagnosed with VTE after trauma.
- Employed multivariate techniques to identify risk factors for VTE.
Main Results:
- VTE risk correlated positively with patient age and Injury Severity Scores (ISS).
- Associated injuries included head, thoracic, abdominal, lower extremity, and spinal trauma.
- Surgical procedures such as craniotomy, laparotomy, and spinal operations increased VTE risk.
- The highest risk for VTE was observed in children with venous catheters.
Conclusions:
- Older children with high ISS, major vascular injuries, craniotomy, or venous catheters are at elevated risk for VTE.
- Findings can guide the development of targeted screening and preventative measures for VTE in pediatric trauma.
- This study highlights the importance of considering VTE in the management of critically ill injured children.
Background:
Venous thromboembolism (VTE) is a major source of morbidity in critically ill trauma patients. Although the incidence and risk factors for VTE after trauma in adults have been well described, similar data regarding pediatric patients are lacking.
Methods:
Pediatric (age < 16 years) trauma patients with VTE were identified from a large administrative database collated from 19 states across the United States. Risk factors for VTE were identified using multivariate techniques.
Results:
Risk of VTE increased with age and Injury Severity Scores. VTE was clearly associated with head, thoracic, abdominal, lower extremity, and spinal injuries. Craniotomy, laparotomy, and spinal operations were also associated with VTE. The greatest risk of VTE was in children with venous catheters.
Conclusion:
Older children with high Injury Severity Scores, major vascular injury, craniotomy, or venous catheters are at risk for VTE. These data may help guide strategies geared toward screening and prophylaxis in injured children.