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Multisite Validation of a Venous Thrombosis Risk Model in Critically Ill Children Through the CHAT Consortium

Julie Jaffray1, Brian R Branchford2, Maua Mosha Alleyne3

  • 1Rady Children's Hospital, University of California, San Diego, San Diego, California, United States.

Blood
|November 24, 2025
PubMed

Insights

The Children's Healthcare Advancements in Thrombosis (CHAT) intensive care unit (ICU) risk assessment model (RAM) effectively identifies critically ill children at risk for hospital-associated venous thromboembolism (HA-VTE). This validated tool aids in determining which pediatric patients may benefit from thromboprophylaxis.

Area of Science:

  • Pediatric critical care medicine
  • Hematology
  • Clinical epidemiology

Background:

  • Critically ill children face a significant risk of hospital-associated venous thromboembolism (HA-VTE).
  • A validated risk assessment model (RAM) is crucial for identifying pediatric patients who could benefit from thromboprophylaxis.

Purpose of the Study:

  • To prospectively validate the Children's Healthcare Advancements in Thrombosis (CHAT) intensive care unit (ICU) VTE RAM.
  • To assess the discriminatory ability and calibration of the CHAT-ICU RAM in a multicenter pediatric cohort.

Main Methods:

  • Prospective multicenter cohort study involving 4,674 pediatric ICU patients aged 0-21 years.
  • Validated the CHAT-ICU RAM, which includes variables such as CVC, immobility, congenital heart disease, autoimmune/inflammatory conditions, and hospital stay ≥3 days.
  • Assessed model performance using area under the receiver operating characteristic (AUROC) curves and calibration plots.

Main Results:

  • The CHAT-ICU RAM demonstrated good discriminatory validity with an AUROC of 0.71 (95% CI: 0.64-0.78).
  • The model showed good calibration, with a calibration slope of 1.0 (95% CI: 0.87-1.14).
  • Risk scores from the RAM correlated with estimated probabilities of HA-VTE, ranging from 1% to 17.4%.

Conclusions:

  • The CHAT-ICU RAM is a well-calibrated and valid tool for identifying pediatric ICU patients at high and low risk of HA-VTE.
  • This risk assessment model can reliably guide decisions regarding thromboprophylaxis in critically ill children.
  • The study confirms the clinical utility of the CHAT-ICU RAM in a diverse multicenter pediatric population.

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