Development of a Risk Model for Pediatric Hospital-Acquired Thrombosis: A Report from the Children's Hospital-Acquired Thrombosis Consortium

Jaffray, Julie; Branchford, Brian R.; Goldenberg, Neil A.; Malvar, Jemily; Croteau, Stacy E.; Silvey, Michael; Fargo, John H.; Cooper, James D.; Bakeer, Nihal; Sposto, Richard; Ji, Lingyun; Zakai, Neil A.; Faustino, E. Vincent S.; Stillings, Amy; Krava, Emily; Young, Guy; Mahajerin, Arash

doi:10.1016/j.jpeds.2020.09.016

Cited by 28 publications

(27 citation statements)

References 48 publications

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“…Obesity was defined as body mass index for age-weight that is greater than or equal to 95% percentile per the Centers for Disease Control and Prevention (22). A platelet count greater than 350 K/uL was used as a marker of VTE risk based on previous work from the CHAT Consortium group (15). In order to standardize mobility and quantitatively asses this variable, the mobility portion of the Braden Q score was used.…”

Section: Data Collection Management and Quality Assurancementioning

confidence: 99%

A New Risk Assessment Model for Hospital-Acquired Venous Thromboembolism in Critically Ill Children: A Report From the Children’s Hospital-Acquired Thrombosis Consortium

Jaffray

Mahajerin

Branchford³

et al. 2021

Pediatric Critical Care Medicine

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To create a risk model for hospital-acquired venous thromboembolism in critically ill children upon admission to an ICU. DESIGN:Case-control study. SETTING:ICUs from eight children's hospitals throughout the United States. SUBJECTS:Critically ill children with hospital-acquired venous thromboembolism (cases) 0-21 years old and similar children without hospital-acquired venous thromboembolism (controls) from January 2012 to December 2016. Children with a recent cardiac surgery, asymptomatic venous thromboembolism, or a venous thromboembolism diagnosed before ICU admission were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:The multi-institutional Children's Hospital-Acquired Thrombosis registry was used to identify cases and controls. Multivariable logistic regression was used to determine the association between hospital-acquired venous thromboembolism and putative risk factors present at or within 24 hours of ICU admission to develop the final model. A total of 548 hospital-acquired venous thromboembolism cases (median age, 0.8 yr; interquartile range, 0.1-10.2) and 187 controls (median age, 2.4 yr; interquartile range, 0.2-8.3) were analyzed. In the multivariable model, recent central venous catheter placement (odds ratio, 4.4; 95% CI, 2.7-7.1), immobility (odds ratio 3.6, 95% CI, 2.1-6.2), congenital heart disease (odds ratio 2.9, 95% CI, 1.7-4.7), length of hospital stay prior to ICU admission greater than or equal to 3 days (odds ratio, 2.5; 95% CI, 1.1-5.6), and history of autoimmune/inflammatory condition or current infection (odds ratio, 2.1; 95% CI, 1.2-3.4) were each independently associated with hospital-acquired venous thromboembolism. The risk model had an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.73-0.84). CONCLUSIONS:Using the multicenter Children's Hospital-Acquired Thrombosis registry, we identified five independent risk factors for hospitalacquired venous thromboembolism in critically ill children, deriving a new hospital-acquired venous thromboembolism risk assessment model. A prospective validation study is underway to define a high-risk group for risk-stratified interventional trials investigating the efficacy and safety of prophylactic anticoagulation in critically ill children.

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Section: Data Collection Management and Quality Assurancementioning

confidence: 99%

A New Risk Assessment Model for Hospital-Acquired Venous Thromboembolism in Critically Ill Children: A Report From the Children’s Hospital-Acquired Thrombosis Consortium

Jaffray

Mahajerin

Branchford³

et al. 2021

Pediatric Critical Care Medicine

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“…The CHAT Registry consists of subjects aged 0–21 years diagnosed with an imaging confirmed hospital‐acquired venous thromboembolism (HA‐VTE) as well as non‐VTE hospitalized controls. Full methodological details of subject inclusion and exclusion criteria along with data collection details for the Registry have been previously published 10,11 . In brief, data were collected from consecutive HA‐VTE subjects at each institution, including demographics, past medical history, and hospital course from January 1, 2012 to March 13, 2020.…”

Section: Methodsmentioning

confidence: 99%

“…Full methodological details of subject inclusion and exclusion criteria along with data collection details for the Registry have been previously published. 10,11 In brief, data were collected from consecutive HA-VTE subjects at each institution, including demographics, past medical history, and hospital course from January 1, 2012 to March 13, 2020. HA-VTE subjects were included in the CHAT Registry if they lacked symptoms of a VTE at hospital admission and were later diagnosed with a radiographically confirmed VTE during their hospitalization.…”

Section: Registry and Study Subjectsmentioning

confidence: 99%

Symptomatic pulmonary embolus after catheter removal in children with catheter related thrombosis: A report from the CHAT Consortium

Jaffray

Kreuziger

Branchford

et al. 2022

Journal of Thrombosis and Haemostasis

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Background: Appropriate timing of central venous catheter (CVC) removal, in relation to start of anticoagulation, in children after the diagnosis of a CVC-related thrombosis (CRT) is not well established. Objectives: This retrospective cohort study evaluated the incidence of symptomatic pulmonary embolism (PE) after CVC removal using data from the multi-institutional Children's Hospital-Acquired Thrombosis (CHAT) Consortium Registry. Patients/Methods: The CHAT Registry consists of data from children aged 0-21 years with a hospital-acquired venous thromboembolism. Eligible subjects were those with CRT diagnosed <3 days after CVC removal. Subjects were excluded if the CRT was due to a failed CVC insertion. Subjects were divided into three groups: those with CVC removal without anticoagulation, those with CVC removal <48 h after starting anticoagulation, and those with CVC removal ≥48 h after starting anticoagulation.

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“…Leading risk factors for VTE in adolescent inpatients include malignancy, surgery, autoimmune disease, inherited thrombophilia, and central venous catheters. [7][8][9] Adolescent VTE prophylaxis guidelines differ from adult guidelines, with less emphasis on pharmacologic VTE prophylaxis and most patients getting IPCD and encouragement to ambulate early. [8][9][10][11][12][13] In 2018, the high rate of VTE reports at University of Illinois Hospital and Health Sciences System (UI Health) led hospital leadership to begin an urgent campaign to reduce VTE.…”

Section: Background/problem Statementmentioning

confidence: 99%

“…[7][8][9] Adolescent VTE prophylaxis guidelines differ from adult guidelines, with less emphasis on pharmacologic VTE prophylaxis and most patients getting IPCD and encouragement to ambulate early. [8][9][10][11][12][13] In 2018, the high rate of VTE reports at University of Illinois Hospital and Health Sciences System (UI Health) led hospital leadership to begin an urgent campaign to reduce VTE. Nurses on all hospital inpatient units were tasked with VTE prophylaxis adherence.…”

Section: Background/problem Statementmentioning

confidence: 99%

Improving VTE prophylaxis adherence among hospitalized adolescents using Human-Centered Design

Kim

Klugman

Norell

et al. 2021

Journal of Patient Safety and Risk Management

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Background/problem statement Venous thromboembolism (VTE) is the leading cause of preventable hospital mortality in the United States; however, compliance with VTE prophylaxis is poor. Most materials for education about VTE prophylaxis are oriented toward adults rather than adolescents, for whom VTE risks are lower and prophylaxis indications differ. We hypothesized that educational materials for adolescents could improve compliance with VTE prophylaxis, reduce nurse burden for initiating and maintaining VTE prevention practices, and reduce practice variation by standardizing the conversation between clinicians and patients. Methods A multidisciplinary team including physicians, nurses, quality experts, communication designers, service designers, and medical students applied a human-centered design (HCD) process to define, iteratively prototype, and test education tools for nurses assigned to adolescents. We piloted a suite of six educational tools for adolescent VTE prophylaxis to fit into the existing hospital workflow. Results An in-room poster was selected after 85% of nurses responded favorably to this intervention. Adolescent adherence with Intermittent Pneumatic Compression Device increased from 69% to 79%, attaining the benchmark goal of 78%. Staff reported greater confidence in educating adolescent patients after the intervention: 62% of nurses and 72% of residents. Conclusion An HCD process helped nurses improve VTE prophylaxis for adolescents with an in-room poster and messaging strategy. Engaging staff in the design increased receptivity and adoption. The piloted materials also helped to create an environment of shared priority among the clinicians.

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Development of a Risk Model for Pediatric Hospital-Acquired Thrombosis: A Report from the Children's Hospital-Acquired Thrombosis Consortium

Cited by 28 publications

References 48 publications

A New Risk Assessment Model for Hospital-Acquired Venous Thromboembolism in Critically Ill Children: A Report From the Children’s Hospital-Acquired Thrombosis Consortium

A New Risk Assessment Model for Hospital-Acquired Venous Thromboembolism in Critically Ill Children: A Report From the Children’s Hospital-Acquired Thrombosis Consortium

Symptomatic pulmonary embolus after catheter removal in children with catheter related thrombosis: A report from the CHAT Consortium

Improving VTE prophylaxis adherence among hospitalized adolescents using Human-Centered Design

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