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Venous thromboembolism in the setting of pediatric traumatic brain injury
1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Insights
Children with traumatic brain injury (TBI) have a higher risk of venous thromboembolism (VTE). Key risk factors include older age, venous catheterization, mechanical ventilation, and nonaccidental trauma.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Vascular medicine
Background:
- Venous thromboembolism (VTE) is rare in children but can be serious.
- The incidence and risk factors for VTE in pediatric patients with traumatic brain injury (TBI) are not well-defined.
Purpose of the Study:
- To characterize the incidence of VTE in children hospitalized for TBI.
- To identify risk factors associated with VTE in this pediatric population.
Main Methods:
- Cross-sectional study utilizing the Healthcare Cost and Utilization Project Kids' Inpatient Database (2009).
- Analysis of hospital discharge data for patients aged 20 years or younger with TBI-related admissions.
- Logistic regression analysis to determine risk factors for VTE.
Main Results:
- The study included 58,529 children with TBI-related admissions, with 267 diagnosed with VTE.
- The incidence of VTE was 4.6 per 1000 TBI hospitalizations, compared to 1.2 per 1000 overall pediatric hospitalizations.
- Significant risk factors for VTE included older age (15-20 years), venous catheterization, mechanical ventilation, tracheostomy, nonaccidental trauma, longer length of stay, orthopedic surgery, and cranial surgery.
Conclusions:
- Children with TBI face an elevated risk of VTE.
- Identified risk factors for VTE in pediatric TBI patients include older age, venous catheterization, nonaccidental trauma, prolonged hospital stay, and specific surgical interventions.
Object:
The risk of venous thromboembolism (VTE) in children with traumatic brain injury (TBI) has not been well characterized given its rarity in the pediatric population. Investigation of risk factors for VTE in this group requires the use of a large sample size. Using nationally representative hospital discharge data for 2009, the authors of this study characterize the incidence and risk factors for VTE in children hospitalized for TBI.
Methods:
The authors conducted a cross-sectional study using data from the Healthcare Cost and Utilization Project Kids' Inpatient Database to examine VTE in TBI-associated hospitalizations for patients 20 years of age or younger during the year 2009.
Results:
There were 58,529 children with TBI-related admissions, including 267 with VTE diagnoses. Venous thromboembolisms occurred in 4.6 per 1000 TBI-associated hospitalizations compared with 1.2 per 1000 pediatric hospitalizations overall. By adjusted logistic regression, patients significantly more likely to be diagnosed with VTE had the following: older age of 15-20 years (adjusted odds ratio [aOR] 3.7, 95% CI 1.8-8.0), venous catheterization (aOR 3.0, 95% CI 2.0-4.6), mechanical ventilation (aOR 1.9, 95% CI 1.2-2.9), tracheostomy (aOR 2.3, 95% CI 1.3-4.0), nonaccidental trauma (aOR 2.8, 95% CI 1.1-6.9), increased length of stay (aOR 1.02, 95% CI 1.01-1.03), orthopedic surgery (aOR 2.4, 95% CI 1.8-3.4), and cranial surgery (aOR 1.8, 95% CI 1.1-2.8).
Conclusions:
Using the Kids' Inpatient Database, the authors found that risk factors for VTE in the setting of TBI in the pediatric population include older age, venous catheterization, nonaccidental trauma, increased length of hospital stay, orthopedic surgery, and cranial surgery.
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