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Venous Thromboprophylaxis in Pediatric Trauma Patients: Adult Versus Pediatric Trauma Centers
Omar Hejazi1, Muhammad Haris Khurshid1, Francisco Castillo Diaz1
1Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
Insights
Pediatric trauma patients receive venous thromboembolism (VTE) prophylaxis inconsistently. Adult trauma centers (ATCs) showed higher prophylaxis rates than pediatric trauma centers (PTCs), yet VTE events were rare and outcomes similar across both center types.
Area of Science:
- Trauma Surgery
- Pediatric Critical Care
- Pharmacology
Background:
- Venous thromboembolism (VTE) prophylaxis practices lack standardization in pediatric trauma care.
- Significant variations exist in VTE prophylaxis and thromboembolic event rates between adult trauma centers (ATCs) and pediatric trauma centers (PTCs).
Purpose of the Study:
- To compare VTE prophylaxis rates and thromboembolic events in pediatric trauma patients admitted to ACS-verified ATCs versus verified PTCs.
- To identify factors associated with VTE prophylaxis and outcomes in severe pediatric trauma.
Main Methods:
- Retrospective analysis of the ACS-Trauma Quality Improvement Program (2017-2020) for pediatric trauma patients (age <15, ISS ≥16).
- Exclusion criteria included in-hospital mortality within 24 hours, burns, and pre-existing bleeding disorders.
- Cohort stratified into ATCs and PTCs; outcomes assessed were VTE prophylaxis, thromboembolic events, and in-hospital mortality.
Main Results:
- Overall VTE prophylaxis was 9.9%, with higher rates in ATCs (12.9%) vs. PTCs (8.7%) (P < 0.001).
- VTE events were infrequent (0.7%), occurring less in ATCs (0.4%) vs. PTCs (0.9%) (P = 0.017).
- Admission to an ATC was independently associated with higher odds of receiving VTE prophylaxis (aOR: 1.47, P < 0.001).
Conclusions:
- Considerable practice variation in VTE chemoprophylaxis exists between ATCs and PTCs.
- VTE events are uncommon in pediatric trauma patients, with similar clinical outcomes regardless of center type.
- Risk-adapted, pediatric-specific guidance is recommended over uniform protocols for VTE prophylaxis.
Introduction:
The practices of venous thromboembolism (VTE) prophylaxis are not standardized in pediatric trauma patients. We aimed to compare the rates of VTE prophylaxis and thromboembolic events in pediatric patients admitted to American College of Surgeons (ACS)-verified adult trauma centers (ATCs, nonpediatric verified) versus verified pediatric trauma centers (PTCs).
Methods:
We conducted a retrospective analysis of the ACS-Trauma Quality Improvement Program (2017-2020) including all pediatric (age <15 y) trauma patients with severe injuries (injury severity score ≥16). We excluded patients who died within 24 h of admission, burn patients, and those with known bleeding disorders. We stratified our cohort into two groups based on their admission to ACS-verified ATCs (nonpediatric verified) or verified PTCs. Our outcomes included receipt of VTE prophylaxis, thromboembolic events, and in-hospital mortality.
Results:
We identified 6730 pediatric patients over 4 y (PTC: 70.7%; ATC: 29.3%). The mean (standard deviation) age was 8 (4) y and 61.5% were male. The median emergency department Glasgow Coma Scale was 15 [9-15] and mean (standard deviation) emergency department systolic blood pressure was 116 (21) mmHg. Overall, 9.9% received VTE prophylaxis and low molecular weight heparin was the most common anticoagulant used (57.1%), followed by heparin (42.6%), and direct thrombin inhibitors (0.0%). Rates of VTE prophylaxis were significantly higher in the ATC group than PTC (12.9% versus 8.7%, P < 0.001). On univariate analysis, VTE events were rare overall (0.7%) and occurred less frequently at ATCs than at PTCs (0.4% versus 0.9%, P = 0.017); there was no difference in unplanned return to operating room or in-hospital mortality (P > 0.05). On multivariable analysis, admission to ATC was independently associated with higher odds of receipt of VTE prophylaxis (adjusted odds ratio: 1.47, confidence interval [1.21-1.79], P < 0.001).
Conclusions:
Considerable practice variation exists in chemoprophylaxis use between center types, while VTE events were uncommon and clinical outcomes were similar. These observations support risk-adapted, pediatric-specific guidance and judicious use rather than uniform protocol standardization. Future work should evaluate risk-stratified approaches and implementation outcomes across center types.
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