Risk factors for deep venous thrombosis in pediatric trauma patients: A review of the National Trauma Data Bank from 2017 to 2022
Related Experiment Video
Updated: Sep 17, 2025
Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Jared Griffard1, Thomas Irons, Sarah Xiao
1From the Department of Surgery, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada.
Insights
Pediatric trauma patients aged 13+ with severe injuries, early packed red blood cell transfusions, or lower extremity injuries face higher deep venous thrombosis (DVT) risks. Delayed venous thromboembolism (VTE) prophylaxis beyond 6 days significantly increases DVT risk in these patients.
Area of Science:
- Pediatric Trauma Care
- Epidemiology of Thrombosis
- Injury Severity Assessment
Background:
- Pediatric trauma patients rarely receive venous thromboembolism (VTE) prophylaxis, despite potential risks.
- While deep venous thrombosis (DVT) rates are generally low, specific risk factors like lower extremity orthopedic injuries, traumatic brain injuries, and increased injury severity in older children require further investigation.
- Identifying high-risk pediatric trauma patients is crucial for targeted VTE prophylaxis strategies.
Purpose of the Study:
- To identify risk factors for deep venous thrombosis (DVT) in pediatric trauma patients.
- To analyze the association between patient characteristics, injury severity, and DVT development.
- To inform evidence-based guidelines for VTE prophylaxis in pediatric trauma populations.
Main Methods:
- Retrospective cohort study utilizing the National Trauma Data Bank (2017-2022).
- Inclusion of pediatric trauma patients (≤17 years) with and without DVT for comparative analysis.
- Logistic regression modeling to determine significant risk factors for DVT in this population.
Main Results:
- Out of 693,729 pediatric trauma patients, 786 (0.11%) developed DVT.
- Significant risk factors for DVT included: age 13 years or older (OR 2.444), early packed red blood cell (PRBC) transfusion (OR 3.436), Injury Severity Score (ISS) >15 (OR 3.650), and higher lower-extremity Abbreviated Injury Scale (AIS) scores (OR 1.665).
- Delayed VTE prophylaxis (administered >6 days post-admission) was strongly associated with increased DVT risk (OR 11.590).
Conclusions:
- Pediatric trauma patients aged 13 and older with severe injuries (ISS >15), early PRBC transfusion, or significant lower-extremity AIS scores are at higher risk for DVT.
- Delayed administration of VTE prophylaxis beyond six hospital days substantially increases DVT risk in these identified high-risk patients.
- Consideration of VTE prophylaxis is recommended for these specific pediatric trauma patient subgroups.
Introduction:
Pediatric trauma patients rarely receive venous thromboembolism (VTE) prophylaxis but have low rates of deep venous thrombosis (DVT). Patients with lower extremity orthopedic injuries, patients with traumatic brain injuries, more severely injured patients, and older children may be at higher risk, but these risk factors have not been examined together for a large population.
Methods:
The National Trauma Data Bank was queried from 2017 to 2022 for patients 17 years or younger and patients with DVT to create a retrospective cohort study with this subset compared with pediatric patients without DVT. Categorical variables were analyzed with χ 2 test, and continuous variables, with t test. A logistic regression model was performed to determine risk factors for DVT in pediatric trauma patients.
Results:
From 2017 to 2022, there were 693,729 pediatric trauma patients, of which 786 (0.11%) had a DVT. The DVT group was older (13.64 vs. 9.70 years, p < 0.0001) and more likely to be male (71.63% vs. 64.65%, p < 0.0001), proceeded immediately to operating room (41.6% vs. 14.63%, p < 0.001), received packed red blood cells (PRBCs) ≤4 hours (47.71% vs. 9.94%, p < 0.0001), received fresh frozen plasma ≤4 hours (33.46% vs. 1.22%, p < 0.0001), and had an Injury Severity Score (ISS) of >15 (87.02% vs. 43.19%, p < 0.0001). A logistic regression model demonstrated that patients age 13 years or older had an odds ratio of 2.444 (confidence interval, 1.137-5.250; p = 0.022). Other significant risk factors included PRBC ≤4 hours of arrival (odds ratio, 3.436; confidence interval, 1.574-7.502; p = 0.022), ISS of >15 (odds ratio, 3.650; confidence interval, 1.071-12.440; p < 0.038), increased lower-extremity Abbreviated Injury Scale scores (odds ratio, 1.665; confidence interval, 1.236-2.243; p = 0.001), and VTE prophylaxis administered more than 6 days after admission (odds ratio, 11.590; confidence interval, 5.695-23.584; p < 0.0001).
Conclusion:
Venous thromboembolism prophylaxis should be considered in pediatric patients who are 13 years or older, have received PRBC early, and have severe ISS and/or higher lower-extremity Abbreviated Injury Scale score; delayed VTE prophylaxis beyond 6 hospital days increases risk of DVT in patients with these risk factors.
Level Of Evidence:
Prognostic and Epidemiological; Level III.
Related Concept Videos
01:30Venous Thrombosis I: Introduction
01:29Venous Thrombosis III: Interprofessional Care
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
01:30Venous Thrombosis IV: Nursing Management
01:26Varicose Veins I: Introduction
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care