Diagnostic value of D‐dimers for limb deep vein thrombosis in children: A prospective study

Avila, Laura; Amiri, Nour; Pullenayegum, Eleanor; Sealey, Victoria Abigail; De, Riddhita; Williams, Suzan; Vincelli, Jennifer; Brandão, Leonardo R.

doi:10.1002/ajh.26212

Cited by 7 publications

(5 citation statements)

References 33 publications

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“…The D-dimer test showed high sensitivity but relatively intermediate specificity at cutoff ≥500 ng/mL and AUC at 0.7. Our test performance was similar to that in Kanis et al ( 17 ) and other previous studies ( 18 , 19 ) that demonstrated high sensitivity of the D-dimer test for DVT. Additionally, a meta-analysis in adults by Stein et al reported that the sensitivity and specificity of the D-dimer test at cutoff >500 ng/mL ranged from 78% to 97% and 42% to 70%, respectively ( 9 ).…”

Section: Discussionsupporting

confidence: 91%

“…However, there was no significant difference in the high D-dimer level cutoff of 500 ng/mL between the tumor (55.8%) and non tumor (64.9%) groups with p -value = 0.202. The explanation is that conditions other than tumors, such as trauma, infection, inflammation, cardiac, and renal diseases, also contribute to D-dimer elevation, possibly by fibrin clot activation ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

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Deep vein thrombosis screening in pediatric orthopedic patients

et al. 2023

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BackgroundDeep vein thrombosis (DVT) is an important clinical condition that leads to subsequent morbidity and mortality in children, particularly those who involved operative procedures. The preoperative assessment for DVT in children may vary among different population risk factors and types of surgery. This study aimed to evaluate the screening methods for DVT in pediatric orthopedic patients.MethodWe performed a retrospective cohort study of orthopedic patients aged <18 years at Ramathibodi Hospital, Bangkok, Thailand, from 2015 to 2019. The inclusion criteria were children scheduled for orthopedic surgery; who performed a D-dimer test, Wells score, and Caprini score; and who underwent Doppler ultrasonography for DVT screening. The exclusion criteria were incomplete data or inconclusive ultrasonographic results. Age and results of the D-dimer test, Wells score, and Caprini score were collected from all patients. The outcome assessment was ultrasound-proven DVT. The screening abilities of each test were analyzed in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR) for positive and negative tests, and area under the receiver operating characteristic curve (AUC).ResultsA total of 419 children were included in the study. Five (1.19%) patients were diagnosed with DVT. The mean age was 10.16 ± 4.83 years. D-dimer ≥500 ng/mL had a sensitivity of 100% (95% CI: 47.8%–100%), a specificity of 36.7% (95% CI: 32.1%–41.6%), a PPV of 1.9% (95% CI: 0.6%–4.3%), and an NPV of 100% (95% CI: 97.6%–100%). Wells score ≥3 demonstrated a sensitivity of 0% (95% CI: 0%–52.2%), a specificity of 99.3% (95% CI: 97.9%–99.9%), and an LR for a negative test of 1.00 (95% CI: 1.00–1.01). Caprini score ≥11 had a sensitivity of 0% (95% CI: 0%–52.2%) and a specificity of 99.8% (95% CI: 98.7%–100%). The parallel test included D-dimer ≥500 ng/mL, Wells score ≥3, or Caprini score ≥11 points, generating a sensitivity of 100% (95% CI: 47.8%–100%), a specificity of 36.7% (95% CI: 32.1%–41.6%), an LR for a positive test of 1.58 (95% CI: 1.47–1.70), and an AUC of 0.68 (95% CI: 0.66–0.71).ConclusionsThe D-dimer test exhibited moderate ability in predicting the development of DVT among pediatric orthopedic patients requiring surgery. The Wells score and Caprini score had low performance in identifying hospitalized children at increased risk of DVT events.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Deep vein thrombosis screening in pediatric orthopedic patients

et al. 2023

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“…It is known that high D-dimer values cannot be used for diagnosis of paediatric VTE, as there are no clinical studies confirming their effectiveness in the paediatric population (11,44). Moreover, in children D-dimer levels showed better discriminative and predictive ability for DVT in an exploratory sample of patients with no underlying conditions or co-morbidities at the time of diagnosis (45). However, our experience shows that in such complex situations, it could be extremely useful for guidance, considering also that it should be checked in routinely post-surgical haematological re-assessment, already frequently performed for the hormonal electrolyte imbalance risk.…”

Section: Discussionmentioning

confidence: 97%

Vascular complications in craniopharyngioma-resected paediatric patients: a single-center experience

Castelli,

Scagnet,

Mussa

et al. 2024

Front. Endocrinol.

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BackgroundCraniopharyngioma (CP), although slow growing and histologically benign, has high morbidity, mostly related to hypothalamus-pituitary dysfunction and electrolyte imbalance. Increased risk of vascular complications has been described. However, data are still poor, especially in the paediatric population. The aim of our study was to evaluate the occurrence, timing, and predisposing factors of deep venous thrombosis (DVT) and other vascular alterations in neurosurgical paediatric CP patients.Materials and MethodsIn a single-centre, retrospective study, we investigated 19 CP patients (11 males, 8 females, mean age 10.5 ± 4.3 years), who underwent neurosurgery between December 2016 and August 2022, referred to Meyer Children’s Hospital IRCCS in Florence.ResultsFive patients (26.3%) presented vascular events, which all occurred in connection with sodium imbalances. Three DVT (two with associated pulmonary embolism, in one case leading to death) developed in the post-operative period, most frequently at 7-10 days. Elevated D-dimers, a reduced partial activated thrombin time and a prolonged C-reactive protein increase were highly related to thrombotic vascular events. One case of posterior cerebral artery pseudoaneurysm was described soon after neurosurgery, requiring vascular stenting. Superficial vein thrombophlebitis was a late complication in one patient with other predisposing factors.ConclusionCP patients undergoing neurosurgery are at risk of developing DVT and vascular alterations, thus careful follow-up is mandatory. In our study, we found that the phase of transition from central diabetes insipidus to a syndrome of inappropriate antidiuretic hormone secretion may be a period of significant risk for DVT occurrence. Careful vascular follow-up is mandatory in CP-operated patients.

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“…Doppler ultrasound, according to several articles, is a good choice that is both readily available and dependable in both the lower and upper extremities [14,15]. D-dimer levels were found to have poor discriminative and predictive power for DVT in one study [16]. However, due of its high diagnostic sensitivity but limited specificity, a normal D-dimer is more beneficial in excluding DVT in children [17].…”

Section: Discussionmentioning

confidence: 99%

Pediatric deep venous thrombosis associated with Staphylococcus aureus osteomyelitis

Liu

Guo

Wang

et al. 2023

J Infect Dev Ctries

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Introduction: Our objective was to evaluate clinical features of children with deep venous thrombosis (DVT) and acute hematogenous osteomyelitis (AHO) caused by Staphylococcus aureus. Methodology: We analyzed 4 years of medical records of patients with AHO and DVT caused by Staphylococcus aureus (S. aureus) and compared clinical and biochemical characteristics of AHO with and without DVT, as well as patients whose DVT dissolved in ≥ 3 weeks. Results: DVT was found in 19/87 AHO individuals (22%). The median age was 9 years (range: 0.5-15 years). 74% (14/19) patients were boys. Methicillin-susceptible Staphylococcus aureus (MSSA) was present in 58% (11/19) cases. The femoral vein and common femoral vein were the two most damaged veins (9 cases each). Anticoagulation therapy with low molecular weight heparin was given to 18 (95%) patients. Within 3 weeks of anticoagulation, 7/13 (54%) with available data had completely resolved DVT. There was no rehospitalization due to bleeding or recurrent DVT. Patients with DVT were found to be older and had increased levels of C-reactive protein, procalcitonin, D-dimer, positive blood culture, incidence of intensive care unit admission, multifocal rate, and length of hospital stay. We did not find clinical difference between patients whose DVT dissolved within 3 weeks and those with > 3 weeks. Conclusions: Over 20% of patients with S. aureus AHO developed DVT. MSSA accounted for more than half of the cases. DVT was completely resolved in more than half of the cases after 3 weeks of anticoagulant medication, with no sequelae.

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Diagnostic value of D‐dimers for limb deep vein thrombosis in children: A prospective study

Cited by 7 publications

References 33 publications

Deep vein thrombosis screening in pediatric orthopedic patients

Deep vein thrombosis screening in pediatric orthopedic patients

Vascular complications in craniopharyngioma-resected paediatric patients: a single-center experience

Pediatric deep venous thrombosis associated with Staphylococcus aureus osteomyelitis

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