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Risk-prediction tool for identifying hospitalized children with a predisposition for development of venous
A A Sharathkumar1, A Mahajerin, L Heidt
1Ann and Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. asharathkumar@luriechildrens.org
Insights
A new Peds-Clot clinical Decision Rule (PCDR) identifies children at high risk for venous thromboembolism (VTE). This tool aids in developing evidence-based prevention guidelines for pediatric VTE.
Area of Science:
- Pediatric Medicine
- Hematology
- Clinical Decision Rules
Background:
- Increasing prevalence of venous thromboembolism (VTE) in pediatric tertiary care settings.
- Need for standardized criteria to identify high-risk pediatric populations for VTE prevention.
Purpose of the Study:
- Develop the Peds-Clot clinical Decision Rule (PCDR) to identify children at increased risk of VTE.
- Establish a risk prediction model for pediatric VTE.
Main Methods:
- Retrospective case-control study using derivation and validation cohorts.
- Conditional logistic regression to develop the risk-prediction model.
- ROC curve analysis to evaluate PCDR performance.
Main Results:
- Six risk factors identified: bloodstream infection, central venous catheter, ICU/NICU admission, prolonged hospitalization, immobilization, and birth control pill use.
- PCDR with a score of 3+ identified high-risk children with 70% sensitivity and 80% specificity (AUC 0.852) in the derivation cohort.
- Validation cohort showed 57% sensitivity and 88% specificity (AUC 0.875).
Conclusions:
- The PCDR is a promising tool for identifying high-risk hospitalized children for VTE.
- Clinical utility requires further validation through prospective studies.
Background:
The prevalence of VTE is increasing in tertiary pediatric hospitals. Identification of high-risk populations using uniform criteria is required to develop evidence-based VTE prevention guidelines.
Objective:
To develop a VTE risk prediction rule, the Peds-Clot clinical Decision Rule (PCDR), to identify high-risk children who were at increased risk of developing VTE.
Methods:
This retrospective case-control study developed the PCDR using a derivation cohort (173 cases, 346 controls) and validated it on a separate validation cohort (100 cases, 100 controls). A uniform data collection strategy was applied to derive both the samples. Conditional logistic regression analyses were used to develop a risk-prediction model. Each significant predictor was assigned a score based on its beta coefficient and the PCDR was developed. ROC curves were derived to test the performance of the PCDR.
Results:
Characteristics of derivation and validation cohorts were comparable. Six risk factors (positive blood stream infection, central venous catheter, direct admission to ICU/NICU, hospitalization for ≥ 7 days, immobilization for > 72 h, and use of birth control pills) formed the final risk prediction model (risk score range, 0.5-9.5). A risk score of 3 or more identified high-risk children at a sensitivity of 70% and specificity of 80% and AUC of 0.852 (95% confidence interval, 0.814-0.890). The application of a risk score to the validation sample showed sensitivity 57% and specificity 88% and an AUC of 0.875 (95% confidence interval, 0.82-0.924).
Conclusion:
Incorporation of the PCDR in routine clinical care can be an attractive strategy to identify high-risk hospitalized children with a predisposition for VTE. The clinical utility of the PCDR needs validation in prospective studies.
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