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Clinically important venous thromboembolism in pediatric critical care: a Canadian survey
Afrothite Kotsakis1, Deborah Cook, Lauren Griffith
1Department of Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
Insights
Pediatric intensivists identify key factors, including clinical suspicion and cardiopulmonary comorbidities, that indicate a venous thromboembolism (VTE) is clinically important. Central vein and vena cava involvement are significant radiological findings.
Area of Science:
- Pediatric critical care medicine
- Vascular medicine
- Radiology
Background:
- Pediatric venous thromboembolism (VTE) is an emerging concern in critically ill children.
- Identifying clinically significant VTE is crucial for appropriate management and improved outcomes.
Purpose of the Study:
- To determine which patient factors and radiological features pediatric intensivists associate with clinically important VTE.
- To understand the criteria used by intensivists to assess the significance of VTE in pediatric patients.
Main Methods:
- A survey was distributed to pediatric intensivists to rate the importance of various patient and radiological factors for VTE.
- A 5-point Likert scale was used to assess the likelihood that a factor makes a VTE clinically important.
Main Results:
- Top patient factors identified were clinical suspicion of pulmonary embolism, symptoms, physical exam findings, and cardiopulmonary comorbidities.
- Radiological features deemed most important included VTE involving the vena cava extending into the right atrium and central veins.
Conclusions:
- Pediatric intensivists utilize specific patient characteristics and thrombus attributes to define clinically important VTE.
- These findings highlight the clinical judgment involved in VTE assessment in pediatric critical care.
Purpose:
Pediatric venous thromboembolism (VTE) is becoming an increasingly recognized morbidity associated with critical illness. The objective of this survey is to identify the patient factors and radiological features that pediatric intensivists consider more or less likely to make a venous thrombosis (VTE) clinically important in their patients.
Materials And Methods:
Our definition of clinically important VTE was a VTE likely to result in short- or long-term morbidity or mortality if left untreated. We asked respondents to rate the likelihood that patient factors and radiological features make a venous thrombosis clinically important using a 5-point scale (1 = much less likely to 5 = much more likely).
Results:
The 38 (58.5%) of 65 pediatric intensivists responding rated 4 patient factors as most likely to make a VTE clinically important: clinical suspicion of pulmonary embolism (mean score, 4.8), symptoms (mean, 4.5), detection by physical exam (mean, 4.4), and the presence of an acute or chronic cardiopulmonary comorbidity that might limit a patient's ability to tolerate pulmonary embolism (mean, 4.3). Of the radiological features, the 2 considered most important were VTE involving the vena cava extending into the right atrium (mean, 5) and central veins (mean, 4.5).
Conclusions:
When labeling a VTE as clinically important, pediatric intensivists rely on several specific patient factors and thrombus characteristics.
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