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Incidence and risk factors for venous thromboembolism in critically ill children after trauma

Sheila J Hanson1, Rowena C Punzalan, Rachel A Greenup

  • 1From the Department of Pediatrics, Critical Care Medicine, Children's Hospital of Wisconsin and Medical College of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 5322, USA. shanson@mcw.edu

The Journal of Trauma
|January 13, 2010
PubMed

Insights

Pediatric venous thromboembolism (VTE) occurs in 6.2% of critically ill children after trauma. Risk factors include central venous lines, parenteral nutrition, and deep sedation, highlighting the need for vigilant monitoring and prophylaxis.

Area of Science:

  • Pediatric critical care medicine
  • Pediatric thrombosis
  • Trauma patient management

Background:

  • Venous thromboembolism (VTE) is a significant cause of morbidity in adult trauma patients.
  • VTE incidence is lower in children but not well-studied in critically ill pediatric trauma patients.

Purpose of the Study:

  • To determine the incidence of VTE in critically ill children after trauma.
  • To identify risk factors associated with VTE development in this population.

Main Methods:

  • A nested case-control study was conducted.
  • Included children under 18 admitted to a pediatric intensive care unit (PICU) at a level I trauma center.
  • Three controls were matched for each VTE case.

Main Results:

  • The incidence of VTE was 6.2% (95% CI 2.3-10.2) among 144 children.
  • VTE diagnosis occurred at a median of 9 days post-admission, with 67% linked to central venous lines (CVLs).
  • Significant risk factors included parenteral nutrition (OR 20), CVLs (OR 19), deep sedation (OR 13), neuromuscular blockade (OR 10), inotropic support (OR 10), and recombinant factor VIIa.

Conclusions:

  • VTE is not uncommon in critically ill pediatric trauma patients.
  • Multiple risk factors, including central venous lines, poor perfusion, and immobility, contribute to VTE development.
  • Further research into VTE prevention strategies in this vulnerable group is warranted.
Abstract

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