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A Multicenter Cohort Study of Inferior Vena Cava Filter Use in Children
Erin M Blevins1, Karen Glanz2, Yuan-Shung V Huang3
1Department of Pediatrics, Hematology and Oncology, Naval Medical Center San Diego, California.
Insights
Inferior vena cava (IVC) filter use in pediatric patients is rare, primarily occurring in adolescents with venous thromboembolism (VTE). Prophylactic IVC filter placement is associated with orthopedic surgery.
Area of Science:
- Pediatric Medicine
- Vascular Surgery
- Health Outcomes Research
Background:
- Inferior vena cava (IVC) filters are used to prevent pulmonary embolism.
- Understanding IVC filter utilization in pediatric populations is crucial for clinical practice.
- Previous studies have not fully characterized IVC filter use in children.
Purpose of the Study:
- To describe the use of IVC filters in pediatric patients admitted to U.S. children's hospitals.
- To identify factors associated with the prophylactic placement of IVC filters in this demographic.
Main Methods:
- Retrospective multicenter cohort study using the Pediatric Health Information Systems (PHIS) database (2004-2012).
- Included patients <21 years old undergoing IVC filter placement.
- Identified venous thromboembolism (VTE) and anticoagulation use via ICD-9-CM and billing codes.
Main Results:
- 276 pediatric patients received IVC filters over 9 years.
- Median age was 15 years; 76% had a VTE, and 77% received anticoagulation.
- IVC filter placement rate was constant (6/100,000 admissions); orthopedic surgery was linked to prophylactic use (OR 4.5).
Conclusions:
- IVC filter placement in pediatric patients is infrequent, predominantly in adolescents.
- Unlike adult trends, pediatric IVC filter use has not increased over time.
- Placement is mainly indicated for existing venous thrombotic events, with prophylactic use linked to orthopedic procedures.
Background:
To describe inferior vena cava (IVC) filter use in pediatric patients admitted to U.S. children's hospitals and to determine factors associated with prophylactic placement.
Procedure:
This retrospective multicenter cohort study utilized data from the Pediatric Health Information Systems (PHIS) administrative database, with 44 participating children's hospitals. Subjects included for analysis were less than 21 years of age, admitted to a PHIS hospital between January 1, 2004 and December 31, 2012 and had a procedure code for IVC filter placement. ICD-9-CM discharge codes were used to identify subjects with a venous thromboembolism (VTE). Pharmaceutical billing codes were used to identify anticoagulation use.
Results:
During this 9-year-study period, 276 subjects met the inclusion criteria. The median age of subjects was 15 years (range 1 month-20 years). Subjects had an ICD-9-CM code for VTE 76% of the time and were started on anticoagulation after IVC filter placement 77% of the time. The mean number of IVC filters placed per year was 6 per 100,000 admissions (SD-1.4), which was constant throughout the study period (P = 0.12). The median number of filters placed by center was 4.5 (range 0-32). In multivariate analysis, subjects undergoing orthopedic surgery were more likely to have prophylactic placement of an IVC filter (OR 4.5; 95%CI 1.8-11).
Conclusions:
IVC filter placement in pediatric patients remains a rare event and is most common in adolescents. Unlike in adults, pediatric IVC filter placement does not appear to be increasing over time and is predominantly used in the setting of a venous thrombotic event.
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