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Assessment of limb edema in pediatric post-thrombotic syndrome
Maria L Avila1, Brian M Feldman1,2,3, Suzan Williams1
1Department of Pediatrics The Hospital for Sick Children Toronto ON Canada.
Insights
Patient and clinician assessments of limb swelling in children with deep vein thrombosis (DVT) capture different aspects of post-thrombotic syndrome (PTS). These distinct measures are valuable for comprehensive pediatric PTS diagnostic tools.
Area of Science:
- Pediatrics
- Vascular Medicine
- Clinical Assessment
Background:
- Post-thrombotic syndrome (PTS) diagnosis in children involves assessing limb edema as both a patient-reported symptom and a clinician-observed sign.
- The correlation between these two assessment methods for limb edema in pediatric deep vein thrombosis (DVT) patients is not well-defined.
- Discrepancies in assessment could lead to overestimation of PTS severity.
Purpose of the Study:
- To evaluate the correlation between different techniques for assessing limb edema as a sign and as a symptom in children at risk of PTS.
- To determine if patient/proxy-reported limb swelling aligns with clinician-assessed measurements in pediatric upper extremity (UE) and lower extremity (LE) DVT cohorts.
Main Methods:
- Cross-sectional study involving 140 children at risk of PTS (70 with UE-DVT, 70 with LE-DVT).
- Limb edema was measured using patient/proxy reports and clinician assessments including limb circumference difference, limb volume ratio, bioimpedance spectroscopy (BIS) ratio, and durometry ratio.
- Correlation analyses (Pearson or Spearman) were performed separately for UE and LE groups.
Main Results:
- In the UE-DVT group, proxy-reported swelling showed weak to moderate correlation with circumference and volume differences, but not BIS ratio.
- In the LE-DVT group, proxy-reported swelling moderately correlated with thigh circumference difference and volume ratio.
- Patient-reported swelling in the LE-DVT group moderately correlated with the BIS ratio.
Conclusions:
- Patient/proxy-reported and clinician-assessed limb edema capture distinct aspects of PTS in children.
- These differing perspectives justify the inclusion of both symptom and sign assessments in pediatric PTS diagnostic tools.
- Proxy reports better reflect overall limb size, while patient reports in LE may indicate fluid content, suggesting unique clinical relevance for each method.
Background:
Pediatric tools for diagnosis of post-thrombotic syndrome (PTS) include the assessment of limb edema as a symptom (patient/proxy-reported) and as a sign. However, it is unclear whether these two approaches refer to the same clinical aspect of PTS. This could result in overestimation of disease severity. We sought to evaluate the correlation among different techniques to assess limb edema as a sign and as a symptom in children who sustained upper extremity (UE) or lower extremity (LE) deep vein thrombosis (DVT) and were, therefore, at risk of PTS.
Methods:
Limb edema was cross-sectionally measured as a symptom (ie, patient- or proxy-reported) and as a sign (ie, clinician-assessed limb circumference difference, limb volume ratio, bioimpedance spectroscopy ratio (BIS), and durometry ratio) in 140 children at risk of PTS (n = 70 UE-DVT, n = 70 LE-DVT). Item-item correlations were estimated using Pearson or Spearman correlation coefficients, as appropriate, and separately for the UE and LE groups.
Results:
In the UE-DVT group, proxy-reported swelling correlated weakly to moderately with circumference difference and with volume ratio, but not with BIS ratio. In the LE-DVT group, proxy-reported swelling correlated moderately with thigh circumference difference and volume ratio, and patient-reported swelling correlated moderately with BIS ratio.
Conclusion:
Our findings suggest that patient/proxy-reported and clinician-assessed limb edema measure slightly different aspects of PTS, justifying their inclusion in pediatric PTS tools. In addition, proxy-reported swelling was in closer agreement with clinician-assessed total limb size (ie, observed edema), and patient-reported swelling in the LE seemed to reflect limb fluid content (ie, perceived edema).
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