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Published on: February 10, 2023
Risk of Venous Thromboembolism in Pediatric Patients with Surgically Treated Lower-Extremity Fractures: A
Mehul M Mittal1, Katalina V Acevedo1, Pooya Hosseinzadeh2
1Department of Orthopaedics, University of Texas Southwestern Medical Center, Dallas, Texas.
Insights
Adolescents with surgically treated lower-extremity fractures have a higher risk of venous thromboembolism (VTE) than younger children. This suggests considering prophylactic measures for adolescents with femoral or pelvic fractures.
Area of Science:
- Orthopedic Surgery
- Pediatric Medicine
- Vascular Medicine
Background:
- Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant cause of morbidity and mortality in hospitalized patients.
- While rare in the general pediatric population, VTE is a concern in hospitalized children, particularly those with lower-extremity (LE) fractures.
Purpose of the Study:
- To determine the risk of VTE in pediatric patients who underwent surgical treatment for LE fractures.
- To compare VTE incidence across different age groups (children, adolescents, adults) undergoing similar surgical procedures.
Main Methods:
- Retrospective cohort analysis using the TriNetX Research Network (>120 million patient records).
- Comparison of three age-based cohorts: children (<14 years), adolescents (14-17 years), and adults (≥18 years).
- Propensity-score matching was employed to ensure comparable cohorts for VTE incidence analysis.
Main Results:
- A total of 634,880 patients with surgically treated LE fractures were analyzed.
- VTE incidence was 0.2% in children, 1.0% in adolescents, and 4.1% in adults.
- Adolescents had a significantly higher risk of DVT (RR: 3.5) and PE (RR: 3.1) compared to children. Femoral, knee, pelvic, and hip fractures showed the highest VTE risk.
Conclusions:
- The incidence of VTE is higher in adolescents compared to younger children undergoing surgical treatment for LE fractures.
- Findings suggest the potential need for prophylactic VTE measures in adolescents, especially those with femoral or pelvic fractures.
Background:
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a substantial cause of morbidity and mortality among hospitalized patients. Although rare in the general pediatric population, VTE remains a potential concern in hospitalized children, particularly those with lower-extremity (LE) fractures. With this study, we aimed to determine the risk of VTE in pediatric patients with surgically treated LE fractures through a retrospective, propensity-matched, cohort analysis.
Methods:
The TriNetX Research Network, encompassing data from >80 health-care organizations and >120 million patient records, was utilized for this retrospective cohort study comparing 3 age-based cohorts (children [age of <14 years], adolescents [age of 14 to 17 years], and adults [age of ≥18 years]) who underwent surgical treatment of LE fractures between January 1, 2003, and January 1, 2023.
Results:
A total of 634,880 patients with surgically treated LE fractures were included; 13.3% were children, 5.6% were adolescents, and 81.1% were adults. Propensity-score matching was used to compare VTE incidence across cohorts, resulting in 3 independent matched comparisons. Overall, the incidence of VTE (either DVT or PE) was 0.2% in children, 1.0% in adolescents, and 4.1% in adults. Adults had a significantly higher risk of developing DVT (risk ratio [RR]: 17.0; 95% confidence interval [CI]: 14.5 to 20.0) and PE (RR: 21.8; 95% CI: 17.0 to 28.1) compared with children. Similarly, adolescents had a higher risk of DVT (RR: 3.5; 95% CI: 2.7 to 4.4) and PE (RR: 3.1; 95% CI: 2.2 to 4.4) compared with children. The incidence of VTE varied by fracture location, with femoral and knee joint (incidence: 0.5% in children, 2.5% in adolescents) and pelvic and hip joint (incidence: 1.2% in children, 2.8% in adolescents) fractures presenting the highest risk across all age groups.
Conclusions:
The incidence of VTE in a large cohort of pediatric patients undergoing surgical treatment of LE fractures was higher in adolescents than in children. These findings may warrant prophylactic VTE measures in adolescents undergoing surgical treatment of femoral or pelvic fractures.
Level Of Evidence:
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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