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Pulmonary embolism: which pediatric trauma patients are at risk?
Anne K Truitt1, Donald L Sorrells, Eric Halvorson
1Division of Pediatric Surgery, Brown Medical School and Hasbro Children's Hospital, Providence, RI 02905, USA.
Insights
Deep vein thrombosis and pulmonary embolism are rare in pediatric trauma patients. High-risk groups for DVT/PE include older children with low Glasgow Coma Scores and severe injuries.
Area of Science:
- Pediatric Trauma Care
- Thromboembolism Research
- Critical Care Medicine
Background:
- Deep vein thrombosis and pulmonary embolism (DVT/PE) are uncommon in pediatric trauma cases.
- Existing guidelines for DVT/PE prophylaxis in this population are limited.
Purpose of the Study:
- To identify specific subgroups of pediatric trauma patients at increased risk for DVT/PE.
- To inform potential prophylactic strategies in high-risk pediatric trauma patients.
Main Methods:
- A case-control study design was employed.
- Data from pediatric trauma patients with DVT/PE were analyzed.
- Odds ratios (ORs) and confidence intervals (CIs) were calculated for known risk factors using matched trauma controls.
Main Results:
- The overall incidence of DVT/PE in pediatric trauma patients was 0.08% (3 out of 3637).
- Patients who developed DVT/PE had an Injury Severity Score (ISS) >= 25 and an initial Glasgow Coma Score (GCS) <= 8.
- An ISS >= 25 significantly increased the odds of DVT/PE (OR, 82; CI, 7.6-2058).
Conclusions:
- Routine DVT/PE prophylaxis is not recommended for all pediatric trauma patients due to low incidence.
- Pediatric trauma patients aged 9 years or older with a GCS <= 8 and an ISS >= 25 may represent a high-risk group.
- Prophylaxis could be considered for these identified high-risk subgroups.
Background/Purpose:
Deep vein thrombosis and pulmonary embolism (DVT/PE) are rare in pediatric trauma patients, and guidelines for prophylaxis are scarce. The authors sought to identify subgroups of patients who may be at higher risk of developing DVT/PE.
Methods:
Case-control study of pediatric trauma patients with DVT/PE. Odds ratios (ORs) and confidence intervals (CIs) were calculated for known risk factors of PE using matched trauma controls (chi2 analysis).
Results:
A total of 3637 pediatric trauma patients was admitted over the last 7 years. Three patients developed DVT/PE (overall incidence, 0.08%). There were 2 girls and 1 boy, aged 15, 15, and 9 years, respectively. All 3 had an Injury Severity Score (ISS) > or =25 and an initial Glasgow Coma Score (GCS) < or =8. None of the known and potential risk factors significantly increased the OR for developing DVT/PE: age 9 years or older (OR, 3.6; CI, 0.4-26), presence of head injury (OR, 2.9; CI, 0.3-22), female sex (OR, 1.2; CI, 0.15-9.1), GCS < or =8 (OR, 9.2; CI, 0.9-230), except ISS > or =25 (OR, 82; CI, 7.6-2058). The OR for a combination of age and GCS was 106, and the OR for the 3 risk factors (age, ISS, GCS) common to all 3 patients was 114 (CI, 10-5000; P < .001).
Conclusions:
The overall incidence of DVT/PE in pediatric trauma patients is <0.1% and routine prophylaxis is not recommended. Children aged 9 years or older with an initial GCS < or =8 and patients with an estimated ISS > or =25 may constitute a high-risk group in which prophylaxis could be considered.
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