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Do Guidelines Change Practice: A Comparison of Single-Center Adherence After Publication of Pediatric

Cooper Nagaki1, Ian Joseph1, McKensie Hammons2

  • 1Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.

The American Surgeon
|April 18, 2026
PubMed

Insights

Pediatric trauma patients rarely experienced venous thromboembolism (VTE), and adherence to VTE prophylaxis guidelines improved over time. Increased prophylaxis did not lead to more bleeding complications, indicating improved patient safety.

Area of Science:

  • Trauma Surgery
  • Pediatric Critical Care
  • Hematology

Background:

  • Venothromboembolism (VTE) is a rare but serious complication in pediatric trauma.
  • Existing VTE prophylaxis guidelines are primarily for adults, with limited data for pediatric populations.
  • Adherence to established Eastern Association for the Surgery of Trauma (EAST) and Pediatric Trauma Society (PTS) guidelines in pediatric trauma is not well understood.

Purpose of the Study:

  • To assess the rate of VTE prophylaxis in pediatric trauma patients.
  • To evaluate adherence to current EAST/PTS VTE prophylaxis guidelines.
  • To analyze the incidence of VTE and bleeding complications in relation to prophylaxis.

Main Methods:

  • Retrospective cohort study conducted at a Level I/II Trauma Center (2014-2024).
  • Included patients aged 7-18 years with data on VTE prophylaxis, VTE events (DVT/PE), Injury Severity Score (ISS), and pubertal status.
  • Analyzed prophylaxis rates based on EAST/PTS guideline criteria.

Main Results:

  • 1271 patients were included; VTE occurred in 0.31% and bleeding complications in 0.24%.
  • Only 35.4% of eligible patients received prophylaxis, but this increased significantly after guideline publication (20.6% to 39.9%).
  • No increase in VTE or bleeding complications was observed with increased prophylaxis use.

Conclusions:

  • Adherence to pediatric VTE prophylaxis guidelines has improved.
  • Increased VTE prophylaxis in pediatric trauma is safe, with no rise in adverse events.
  • VTE remains rare in this population, even in those not meeting prophylaxis criteria.

Keywords:
ICUpediatric surgerytraumatrauma acute care

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