Inpatient Characteristics and Outcomes of Venous Thromboembolism Among Children and Adolescents

Endogenous venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism (PE), is considered a rare event in pediatric patients, and its health care implications are largely unstudied. However, its burden on the health care system may be disproportionately higher owing to age-specific risk factors.

To evaluate and characterize the inpatient cohort of children and adolescents with VTE and PE.

This nationwide cohort study used data on inpatient cases of VTE in Germany (data source: Federal Bureau of Statistics DESTATIS) from 2020 to 2024. Cases younger than 20 years with VTE as the main or secondary diagnosis, as well as a subcohort with PE as the main diagnosis, were analyzed regarding risk profiles, inpatient care, and outcomes stratified by sex and age.

Hospital-based incidence of VTE (VTE cases per 10 000 inpatient cases per year) and in-hospital mortality.

This study identified 14 108 pediatric inpatient cases of VTE (mean [SD] age, 9.0 [7.3] years; 7201 male [51.0%]), corresponding to a hospital-based incidence of 15.3 per 10 000 pediatric cases per year. A total of 3311 patients with VTE (23.5%), comprising 1361 of 6907 female patients (19.7%) and 1950 of 7201 male patients (27.1%), were infants younger than 1 year. Risk factors for VTE varied, as rates of infection, chronic organ failure, and congenital diseases decreased with increasing patient age, while cancer was most commonly diagnosed among cases aged 5 to 14 years, and thrombophilia remained a relatively constant risk factor across all age groups. PE occurred in 1564 VTE cases (11.1%); among cases whose main diagnosis was PE, 624 of 888 (70.3%) were female. The in-hospital mortality rate in the VTE cohort was 3.7% (522 of 14 108); mortality risk was significantly increased among infants aged 4 years or younger (OR, 3.52 [95% CI, 2.73-4.57]; P < .001).

This cohort study found a marked inpatient health care and economic burden for VTE among children and adolescents. Mortality risk was significantly increased among infants younger than 1 year. Studies are needed to provide evidence-based support for the safety and effectiveness of medical interventions for children and adolescents with VTE.