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Use of vena cava filters in pediatric trauma patients: data from the National Trauma Data Bank
Alan Cook1, Steven Shackford, Turner Osler
1Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont 05401, USA. alan.cook@vtmednet.org
Insights
Vena cava filters (VCFs) are rarely used in pediatric trauma patients, despite being common in adults. Their use is linked to severe injuries and specific hospital types, but long-term effectiveness in children remains unknown.
Area of Science:
- Trauma Surgery
- Pediatric Critical Care
- Vascular Interventions
Background:
- Vena cava filters (VCFs) are used to prevent pulmonary embolism (PE) in high-risk adult trauma patients.
- Limited data exist on VCF utilization in pediatric trauma populations.
Purpose of the Study:
- To investigate the prevalence and predictors of VCF placement in pediatric trauma patients.
- To analyze patient and institutional characteristics associated with VCF use in this demographic.
Main Methods:
- A cross-sectional study analyzed data from the National Trauma Data Bank (NTDB) for patients aged 17 or younger.
- Prevalence of deep vein thrombosis (DVT), PE, and VCF placement was calculated.
- Multivariate logistic regression identified predictors of VCF placement.
Main Results:
- VCFs were placed in 0.18% of 116,357 pediatric trauma patients.
- VCF recipients had more severe injuries, longer hospital and ICU stays.
- Predictors of VCF use included DVT, spinal cord injury, severe femur fracture, increasing age, and higher injury severity score.
Conclusions:
- VCF placement in pediatric trauma is infrequent and associated with specific patient and injury factors.
- The long-term efficacy and optimal application of VCFs in pediatric trauma patients require further research.
Background:
Placement of vena cava filters (VCFs) in high-risk adult trauma patients is a well-described intervention for prophylaxis against pulmonary embolism (PE). Few data exist regarding the use of VCFs in pediatric trauma.
Methods:
We performed a cross-sectional study using the National Trauma Data Bank of the American College of Surgeons. Patients 17 years old or younger were included. Data regarding demographics, injuries, hospitalization, survival, and treating institution were analyzed. The prevalence of deep vein thrombosis (DVT), PE, and VCF placement were calculated. Odds ratios (ORs) for predictors of VCF placement were determined using multivariate logistic regression.
Results:
There were 116,357 pediatric patients in the National Trauma Data Bank. VCFs were placed in 214 (0.18%) patients. VCF patients had longer mean hospital (23.99 vs. 4.12 days) and intensive care unit stays (13.65 vs. 1.12 days) and more severe injuries (mean Injury Severity Score, 30.89 vs. 9.04) than those without VCFs. Sixty-five patients had DVT, and PE was diagnosed in 28 patients, representing 0.06% and 0.02% of the cohort, respectively. University-associated teaching hospitals placed 72.4% (95% confidence interval, 65.9-78.3%) of VCFs and Level I trauma centers placed 46.3% (95% confidence interval, 39.4-53.2%) of VCFs. In multivariate analysis, significant predictors of VCF use were DVT (OR, 33.13), spinal cord injury (OR, 15.28), probability of survival (OR, 10.52), severe femur fracture (OR, 3.39), increasing age (OR, 1.99), ISS (OR, 1.05), intensive care unit stay (OR, 1.04), and length of stay (OR, 1.02). Higher Glasgow Coma Scale score decreased the likelihood of VCF use (OR, 0.87).
Conclusion:
Placement of VCFs in pediatric trauma patients is uncommon and is associated with several characteristics of the patient, the injury, and the treating institution. Long-term VCF efficacy in pediatric trauma is not known, and application of VCFs in these patients requires further investigation.
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