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Hospital-Acquired Venous Thromboembolism Among Children With Tracheostomy: A North American Virtual Pediatric Systems
Elizabeth E Havlicek1, Jamie Palumbo2, Gerardo Soto-Campos2
1Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
Objective:
To evaluate the frequency of hospital-acquired venous thromboembolism (HA-VTE, including limb and neck deep venous thrombosis, pulmonary embolism, and organ-specific VTE) among critically ill children with tracheostomy and determine whether surrogate markers of impaired mobility (i.e., invasive mechanical ventilation [IMV] or a high-intensity neurologic diagnosis) are associated with HA-VTE.
Design:
Multicenter, retrospective study of the Virtual Pediatric Systems database from January 1, 2016 to December 31, 2023.
Setting:
One-hundred forty-two North American PICUs.
Patients:
Children younger than 18 years with a preexisting tracheostomy, excluding neonatal and postoperative encounters, those with a PICU length of stay less than 1 day, and those with VTE present at admission.
Interventions:
None.
Measurements And Main Results:
Of 25,560 encounters, 181 (0.7%) developed a HA-VTE, identified at a median of 9.5 days (interquartile range: 4-19) following hospitalization. Although a larger proportion of children who developed a HA-VTE as compared with not had a high-intensity neurologic diagnosis (66.9% vs. 56.6%, p = 0.006) and greater rate of IMV exposure (92.8% vs. 81.6%, p < 0.001), these immobility surrogate markers were not associated with HA-VTE in an adjusted logistic regression model. Features independently associated with HA-VTE included: prior VTE (adjusted odds ratio [aOR]: 19.2; 95% CI, 7.1-52); central venous catheterization (CVC, aOR: 3; 95% CI, 2.1-4.2); comorbid infection (aOR: 2.2; 95% CI, 1.6-3.2); and an inherited hypercoagulability (aOR: 3.5; 95% CI, 2.6-5.7) (all p < 0.001). Among patients with CVC, concomitant high-intensity neurologic impairment diagnosis (aOR 1.7; 95% CI, 1.1-2.8) was independently associated with HA-VTE.
Conclusions:
In this multicenter study of critically ill children with tracheostomy, HA-VTE occurred in 0.7% of encounters and was associated with presence of a CVC, comorbid infection, prior VTE and inherited hypercoagulability. A surrogate marker of immobility (i.e., high-intensity neurologic diagnoses) was associated with HA-VTE among patients with a CVC.
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