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Pediatric post-thrombotic syndrome in children: Toward the development of a new diagnostic and evaluative measurement
M L Avila1, L R Brandão1, S Williams1
1Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
Insights
Developing a new tool for pediatric post-thrombotic syndrome (PTS) identified key symptoms like pain and swelling. These findings help refine diagnostic criteria for children with deep vein thrombosis.
Area of Science:
- Pediatric Thrombosis Research
- Clinical Tool Development
- Vascular Medicine
Background:
- Pediatric post-thrombotic syndrome (PTS) requires effective diagnostic and evaluative tools.
- Current assessment methods may lack specificity for pediatric cases.
Purpose of the Study:
- To generate and pilot items for a novel discriminative and evaluative tool for pediatric PTS.
- To identify key signs and symptoms indicative of PTS in children.
Main Methods:
- A formative model was employed for tool development, focusing on PTS signs/symptoms.
- Item generation involved pediatric thrombosis experts and patients with childhood PTS.
- Items were piloted in children with limb deep vein thrombosis (DVT) to assess performance.
Main Results:
- 34 items were generated by 23 experts and 16 subjects.
- 140 children with limb DVT (70 upper, 70 lower extremity) were included in piloting.
- Key indicators identified: pain, paresthesia, swollen limb (upper extremity); pain, tired limb, heaviness, tightness, paresthesia (lower extremity).
Conclusions:
- The diagnostic utility of items varied by venous territory (upper vs. lower extremity).
- Item performance correlated with PTS severity, with some symptoms showing higher diagnostic accuracy.
- Findings will guide the selection of items for the new pediatric PTS assessment tool.
Objective:
Our goal was to conduct the item generation and piloting phases of a new discriminative and evaluative tool for pediatric post-thrombotic syndrome.
Methods:
We followed a formative model for the development of the tool, focusing on the signs/symptoms (items) that define post-thrombotic syndrome. For item generation, pediatric thrombosis experts and subjects diagnosed with extremity post-thrombotic syndrome during childhood nominated items. In the piloting phase, items were cross-sectionally measured in children with limb deep vein thrombosis to examine item performance.
Result:
Twenty-three experts and 16 subjects listed 34 items, which were then measured in 140 subjects with previous diagnosis of limb deep vein thrombosis (70 upper extremity and 70 lower extremity). The items with strongest correlation with post-thrombotic syndrome severity and largest area under the curve were pain (in older children), paresthesia, and swollen limb for the upper extremity group, and pain (in older children), tired limb, heaviness, tightness and paresthesia for the lower extremity group.
Conclusion:
The diagnostic properties of the items and their correlations with post-thrombotic syndrome severity varied according to the assessed venous territory. The information gathered in this study will help experts decide which item should be considered for inclusion in the new tool.
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