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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
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Screening and Prophylaxis for Venous Thromboembolism in Pediatric Surgery: A Systematic Review

Lorraine I Kelley-Quon1, Shannon N Acker2, Shawn St Peter3

  • 1Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.

Journal of Pediatric Surgery
|July 4, 2024
PubMed

Insights

Venous thromboembolism (VTE) is infrequent in pediatric surgical and trauma patients. Prophylaxis is recommended for specific high-risk groups, but routine ultrasound screening is not advised.

Area of Science:

  • Pediatric Surgery
  • Trauma Surgery
  • Vascular Medicine

Background:

  • Venous thromboembolism (VTE) presents a rare but significant complication in pediatric surgical and trauma patients.
  • Understanding the epidemiology and risk factors for VTE is crucial for effective management and prevention strategies in this vulnerable population.

Approach:

  • A systematic review of 124 studies (Level 3-4 evidence) was conducted using major medical databases (Medline, Embase, Cochrane, Web of Science) from 2000-2021.
  • The review followed PRISMA guidelines to synthesize data on VTE incidence, screening methods, and prophylaxis strategies.

Key Points:

  • VTE incidence in pediatric surgical patients is 0.29% and in trauma patients is 0.25%, correlating with factors like surgery type, malignancy, injury severity, and prolonged immobilization.
  • Routine ultrasound screening for VTE is not recommended. Mechanical prophylaxis (sequential compression devices) may be considered for nonmobile surgical patients.
  • Pharmacologic prophylaxis, preferably low molecular weight heparin, is recommended for adolescents over 15 and post-pubertal children under 15 with injury severity scores over 25.

Conclusions:

  • While VTE is uncommon in children, targeted mechanical and pharmacologic prophylaxis is warranted in identified high-risk pediatric surgical and trauma populations.
  • Evidence-based recommendations guide the judicious use of VTE screening and prophylaxis in pediatric care settings.
Abstract

Keywords:
Deep vein thrombosisPediatricSurgeryVenous thromboembolism

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