Hospital-associated venous thromboembolism in pediatrics: a systematic review and meta-analysis of risk factors and risk assessment models

Abstract

© F e r r a t a S t o r t i F o u n d a t i o ntors include the relatively low incidence compared with that in adults, slow acceptance by some pediatricians of the increasing incidence of HA-VTE, lack of evidence on preventability, and -in particular -the paucity of studies applying appropriate methodologies for establishing independent risk factors and validating risk models derived from them. Challenges regarding how to best/consistently define a risk factor -e.g. immobility-also exist, as they do in adults.Lending further credence to the importance of developing evidence-based HA-VTE prevention guidelines for children, the International Society of Thrombosis and Haemostasis (ISTH) convened a Working Group, via the Pediatric/Neonatal Hemostasis and Thrombosis Subcommittee Scientific and Standardization Committee (SSC), to develop recommendations for standardization and future research regarding pediatric HA-VTE risk factors and risk assessment models. As a prerequisite to the development of guidelines, current evidence must be rigorously analyzed. Accordingly, the purpose of this report is to present findings of a systematic review and metaanalysis of the literature on pediatric HA-VTE risk factors and risk-assessment models. Methods Search strategyWe identified English articles using PubMed (1946-May, 2014 and Embase (1980-May, 2014. The search strategies comprised "venous thromboembolism," "risk" and "children" with multiple subject headings and text-words per concept. Given the large body of VTE literature, we began with a sensitive query and progressively specified subsequent queries using major focus syntax and text-word title field restrictions. Selectively exploding subject headings, with relevant subcategories, permitted ever-increasing specificity. The full search strategy for Pubmed is available as Online Supplementary Table S1. Study selectionWe excluded studies of patients older than 21 years based on the definition of pediatric age from the National Institute of Child Health and Human Development. 9 For studies that included pediatric and adult patients, we excluded those without clear subanalyses for patients under 21 years. Similarly, we excluded studies on arterial thromboembolism unless cases of VTE were included and clearly delineated in sub-analyses. Studies were categorized as narrative reviews, commentaries, single case reports, retrospective case series, cross-sectional studies, case-control studies, cohort studies (retrospective and prospective), registry studies, or clinical trials, the first three of which were excluded. Cases series were retained if they included at least 40 cases. Conflicting opinions regarding study design, where insufficiently or inconsistently described, were resolved through group consensus. Data extractionThe following data were initially extracted by a pair of reviewers (BB, AM) and independently confirmed by a second pair (LR, CHvO): study design; number of patients/hospital unit; summary statistics on patients' age, gender; VTE location; time from VT...

The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

“…The most important exogenous risk factor is the presence of a CVC. Mahajerin et al completed a systematic review and meta-analysis of risk factors and risk assessment models using case–control and non-case–control studies identifying five independent risk factors for VTE in pediatric hospitalized patients (27). The most significant risk factor for all hospital-acquired VTE (HA-VTE) was a CVC presence, followed by the following populations: those with systemic infection, ICU admission, mechanical ventilation, and prolonged hospital stay.…”

Recommendations for venous thromboembolism prophylaxis in pediatric trauma patients

“…Three authors recently published systematic review articles on VTE prophylaxis in pediatric trauma. 19,20 Articles from 1995 to 2012 constituted the bibliography of the earlier published review. 19 A research librarian expanded and updated the literature search from 2012 to May 2014 according to previously published search parameters.…”

Epidemiology and Risk Assessment of Pediatric Venous Thromboembolism

“…Risk factor data are predominately derived from single-institution, retrospective cohort, or case–control studies (10). …”

“…Differences in the patient population included and analysis make comparison of these studies challenging. The relative contributions of genetic, anatomic, and acquired risk factors in pediatrics have been less studied than in adults (9, 10). Sequelae of VTE, namely post-thrombotic syndrome (PTS) and recurrence risk, have not been fully investigated in children, but efforts to standardize outcome measures are underway (11–13).…”