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Risk factors for venous thromboembolism after pediatric trauma

Casey J Allen1, Clark R Murray1, Jonathan P Meizoso1

  • 1Division of Trauma and Surgical Critical Care, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.

Journal of Pediatric Surgery
|November 9, 2015
PubMed

Insights

Major vascular injury and orthopedic surgery significantly increase pediatric venous thromboembolism (VTE) risk in trauma patients. Many affected children received thromboprophylaxis, highlighting the need for improved VTE prevention strategies.

Area of Science:

  • Pediatric Trauma Care
  • Vascular Surgery
  • Hematology

Background:

  • Venous thromboembolism (VTE) is a significant concern in pediatric trauma.
  • Identifying independent predictors of VTE is crucial for risk stratification.
  • Understanding adult VTE risk factors may inform pediatric VTE prediction.

Purpose of the Study:

  • To identify independent predictors of VTE in pediatric trauma patients.
  • To assess the relative impact of known adult VTE risk factors in this population.
  • To define a high-risk pediatric cohort for VTE following trauma.

Main Methods:

  • Retrospective review of 1934 pediatric trauma admissions (≤ 17 years) over 13 years.
  • Logistic regression analysis to determine independent predictors of VTE.
  • Comparison of identified risk factors with established adult VTE risk factors.

Main Results:

  • VTE occurred in 1.2% of pediatric trauma patients.
  • Orthopedic surgery (OR: 8.10) and major vascular injury (MVI) (OR: 15.43) were independent predictors.
  • Age (OR: 1.59), orthopedic surgery, MVI, and transfusion (OR: 3.37) were significant predictors.
  • When adjusted for adult risk factors, age ≥ 13, central venous catheter, orthopedic surgery, and MVI remained significant.

Conclusions:

  • Major vascular injury (MVI) and orthopedic surgery are synergistic predictors of pediatric VTE.
  • A substantial proportion (86%) of pediatric VTE cases occurred despite thromboprophylaxis.
  • These findings emphasize the need for targeted VTE prevention in high-risk pediatric trauma patients.
Abstract

Keywords:
ChildrenDVTDeep vein thrombosisPediatricsTraumaVTE

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