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Pediatric Orthopaedic Venous Thromboembolism: A Systematic Review Investigating Incidence, Risk Factors, and Outcome
Neha Mulpuri1, Ryan M Sanborn1, Pratik Pradhan1
1Boston Children's Hospital, Boston, Massachusetts.
Insights
Pediatric orthopaedic patients have a low risk of venous thromboembolism (VTE), less than 17 events per 10,000 cases. Trauma cases show the highest VTE incidence, highlighting the need for surgeon awareness of risk factors.
Area of Science:
- Pediatric Orthopaedics
- Vascular Surgery
- Epidemiology
Background:
- Growing evidence suggests increased venous thromboembolism (VTE) incidence in children with trauma or infection.
- Pediatric VTE is a significant concern, particularly in the context of orthopaedic conditions.
Purpose of the Study:
- To systematically review literature on VTE in the pediatric orthopaedic population.
- To estimate the overall incidence of VTE in this group.
- To identify associated risk factors for VTE.
Main Methods:
- Systematic review of literature from 1980-2021 for patients ≤21 years.
- Searched 5 electronic databases, yielding 1,426 articles; 30 selected for full-text review.
- Pooled incidence calculated, and studies stratified by size, trauma vs. elective surgery, and subspecialty.
Main Results:
- 30 articles reported 3,113 VTE events in 2,467,764 pediatric patients (pooled incidence: 20/10,000).
- 26 studies focused on orthopaedics reported 1,108 VTE cases in 850,268 patients (pooled incidence: 16.6/10,000).
- Higher VTE incidence observed in studies with <10,000 patients and those involving trauma. Key risk factors: age, sex, obesity, surgery type, central venous catheter use.
Conclusions:
- The risk of VTE in pediatric orthopaedic surgery or admission is low (<17/10,000).
- Orthopaedic surgeons must recognize VTE risk factors.
- Traumatic etiologies are associated with the highest VTE incidence and warrant special attention.
Background:
There is growing evidence of increased venous thromboembolism (VTE) incidence in children with trauma or infection. The purpose of this study was to conduct a systematic review of existing literature related to VTE in the pediatric orthopaedic population, to estimate the overall incidence of VTE and identify risk factors associated with this condition.
Methods:
A systematic review of the available literature was performed to identify articles that described VTE in pediatric orthopaedic surgery or admission. Literature queries were performed to identify articles published from 1980 to 2021 that included patients ≤21 years of age. A stepwise search strategy of 5 electronic databases yielded 1,426 articles, which were filtered by 2 reviewers to identify 30 articles for full-text review. The primary aim was to determine the rate of VTE, and the secondary aim was to identify risk factors for VTE. The pooled incidence of VTE was estimated and reported in cases per 10,000. Studies were stratified by study size, by trauma versus elective surgery, and by orthopaedic subspecialty.
Results:
The 30 articles reported 3,113 VTE events in 2,467,764 pediatric patients (including those with non-orthopaedic conditions), for a pooled VTE incidence of 20 events (95% confidence interval [CI] = 10.8 to 37.2) per 10,000. Four of the studies were excluded for incomplete data or high heterogeneity. The remaining 26 studies had 850,268 orthopaedic patients with 1,108 cases of VTE, for a pooled VTE incidence of 16.6 events (95% CI = 9.1 to 30.5) per 10,000. Studies with <10,000 patients and those involving a diagnosis of trauma had the highest VTE incidence when stratification was performed. The most frequently analyzed risk factors in 15 available studies included age, sex, obesity/body mass index, type of surgery, and use of a central venous catheter.
Conclusions:
This systematic review indicated that the risk of VTE associated with pediatric orthopaedic surgery or admission remains low, at <17 events per 10,000 cases. However, orthopaedic surgeons should be aware of the most common risk factors associated with pediatric orthopaedic VTE and should pay special attention to traumatic etiologies, as these yielded the highest incidence.
Levels Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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