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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Venous thromboembolism prophylaxis after pediatric trauma
Christina Georgeades1,2, Kyle Van Arendonk3, David Gourlay3
1Division of Pediatric Surgery, Children's Wisconsin, 999 N 92nd Street, Suite 320, Milwaukee, WI, 53226, USA. cgeorgeades@mcw.edu.
Insights
Developing venous thromboembolism (VTE) guidelines for pediatric trauma patients is crucial. Research identifies risk factors and prophylaxis strategies, but optimal guidelines require further study to reduce VTE risk.
Area of Science:
- Pediatric Trauma Care
- Thromboprophylaxis Research
- Venous Thromboembolism (VTE) Prevention
Background:
- Increasing focus on developing and validating venous thromboprophylaxis guidelines for pediatric trauma patients.
- Venous thromboembolism (VTE) remains a significant concern in this population.
- Existing literature highlights various risk factors contributing to VTE incidence.
Purpose of the Study:
- To review current literature on VTE incidence and risk factors in pediatric trauma.
- To evaluate the use and effectiveness of thromboprophylaxis strategies in this demographic.
- To identify gaps in knowledge and areas for future research in VTE prevention.
Main Methods:
- Comprehensive literature review of studies on pediatric trauma and VTE.
- Analysis of identified risk factors including age, injury severity, and comorbidities.
- Examination of current mechanical and pharmacologic prophylaxis approaches.
Main Results:
- Key risk factors for VTE include age, injury severity, central venous catheters, mental status, injury type, surgery, and comorbidities.
- Risk stratification tools guide the implementation of mechanical and/or pharmacologic prophylaxis.
- Pharmacologic prophylaxis (e.g., low molecular weight heparin) is used for high-risk patients, with timing and duration dependent on individual factors.
Conclusions:
- While progress has been made in understanding VTE risk and prophylaxis in pediatric trauma, further research is essential.
- Optimal guidelines for VTE prophylaxis are needed to effectively decrease VTE risk after pediatric trauma.
- Further studies are warranted to refine the type, timing, and duration of VTE prophylaxis.
Abstract:
In recent years, there has been an increased focus on developing and validating venous thromboprophylaxis guidelines in the pediatric trauma population. We review the current literature regarding the incidence of and risk factors for venous thromboembolism (VTE) and the use of prophylaxis in the pediatric trauma population. Risk factors such as age, injury severity, central venous catheters, mental status, injury type, surgery, and comorbidities can lead to a higher incidence of VTE. Risk stratification tools have been developed to determine whether mechanical and/or pharmacologic prophylaxis should be implemented depending on the degree of VTE risk. When VTE risk is high, pharmacologic prophylaxis, such as with low molecular weight heparin, is often initiated. However, the timing and duration of VTE prophylaxis is dependent on patient factors including ambulatory status and contraindications such as bleeding. In addition, the utility of screening ultrasound for VTE surveillance has been evaluated and though they are not widely recommended, no formal guidelines exist. While more research has been done in recent years to assess the most appropriate type, timing, and duration of VTE prophylaxis, further studies are warranted to create optimal guidelines for decreasing the risk of VTE after pediatric trauma.
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