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Published on: February 10, 2023
Epidemiology and Risk Assessment of Pediatric Venous Thromboembolism
Arash Mahajerin1, Stacy E Croteau2
1CHOC Children's Specialists, Orange, FL, USA.
Insights
Pediatric venous thromboembolism (VTE) is rising, particularly in critically ill children. More research is needed to identify risk factors and develop effective prevention strategies for this vulnerable population.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Vascular medicine
Background:
- The incidence of diagnosed venous thromboembolism (VTE) is increasing in pediatric patients, especially those with critical illness or complex medical conditions.
- While overall pediatric VTE rates are low, higher incidences are noted in hospitalized children, those with central venous catheters (CVCs), and post-surgery patients.
- Rising VTE incidence, mortality, morbidity, novel therapies, and healthcare costs necessitate urgent investigation into pediatric VTE risk factors and prevention.
Purpose of the Study:
- To highlight the increasing incidence of pediatric venous thromboembolism (VTE) and its associated risks.
- To identify gaps in current research regarding pediatric VTE risk factors and the limitations of existing studies.
- To emphasize the need for multicenter, prospective studies to develop a reliable pediatric VTE risk-assessment tool and optimize preventive measures.
Main Methods:
- Review of existing literature on pediatric venous thromboembolism (VTE) risk factors.
- Analysis of retrospective, single-institution studies and their limitations in verifying independent risk factors.
- Examination of the prevalence and risk associated with central venous catheters (CVCs) in pediatric VTE.
Main Results:
- Many putative risk factors for pediatric VTE have been reported, but often lack rigorous verification due to study design limitations.
- Central venous catheters (CVCs) are the most common risk factor, though their assigned risk level can be inconsistent across studies.
- Few validated risk-assessment models for hospital-acquired pediatric VTE exist, with existing models often targeting specific subpopulations.
Conclusions:
- There is a critical need for multicenter, prospective studies to accurately identify and confirm pediatric VTE risk factors.
- Developing a validated pediatric risk-assessment tool is essential for optimizing preventive strategies and minimizing harm.
- Improved understanding and management of pediatric VTE are crucial given its increasing incidence and impact on patient outcomes.
Abstract:
The incidence of diagnosed venous thromboembolism (VTE) has been increasing concurrent with advances in technology and medical care that enhance our ability to treat pediatric patients with critical illness or complex multiorgan system dysfunction. Although the overall incidence of VTE is estimated at 0.07-0.49 per 10,000 children, higher rates are observed in specific populations including hospitalized children, those with central venous catheters (CVCs) or patients convalescing from a major surgery. While the absolute number of pediatric VTE events may seem trivial compared to adults, the increasing incidence, associated with increased mortality and morbidity, the availability of novel therapies, and the impact on the cost of care have made investigation of VTE risk factors and prevention strategies a high priority. Many putative risk factors for pediatric VTE have been reported, primarily from single-institution, retrospective studies which lack appropriate methods for verifying independent risk factors. In addition, some risk factors have inconsistent definitions, which vex meta-analyses. CVCs are the most prevalent risk factors but have not consistently been assigned the highest level of risk as defined by odds ratios from retrospective, case-control studies. Few risk-assessment models for hospital-acquired pediatric VTE have been published. Some models focus exclusively on hospitalized pediatric patients, while others target specific populations such as patients with cancer or severe trauma. Multicenter, prospective studies are needed to identify and confirm risk factors in order to create a pediatric risk-assessment tool and optimize preventive measures and reduce unintended harm.
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