Pediatric orthopaedic lower extremity trauma and venous thromboembolism

Abstract

PurposeResearch on venous thromboembolism events (VTE), such as deep venous thrombosis (DVT) and pulmonary embolism (PE), in pediatric orthopaedic trauma patients is sparse. We describe the incidence in the USA of VTE associated with pediatric lower extremity orthopaedic trauma, and characterize injury patterns and VTE treatment methods.MethodsThe Pediatric Health Information System (PHIS) was queried from 2004 to 2013 using ICD-9 codes for lower extremity fractures (pelvis, femur, tibia, ankle, foot) and dislocations (hip, knee, ankle, subtalar) and VTE. Records were queried for age, diagnoses, and VTE treatment.ResultsDuring the study period 285,611 clinical encounters reported lower extremity trauma. Of those, 167 patients were simultaneously coded with VTE (99 DVT, 50 PE, 18 combined DVT/PE), to give an incidence of VTE associated with pediatric lower extremity trauma of 0.058 %. Patients were from 39 centers, with an average age of 12.9 years (range 0–19). There were 249 fractures and 21 dislocations, with 25 (15 %) patients sustaining more than one lower extremity injury. The most common fracture locations were the femur/femoral neck (95), tibia/ankle (92), and pelvis (44). 72 % (121/167) of patients were treated with anticoagulation medication, of which the most common was low-molecular-weight heparin (111/167, 66 %).ConclusionsThe incidence of VTE events associated with lower extremity orthopaedic trauma is 0.058 %. Adolescents and polytrauma patients with injuries of the femur/femoral neck, tibia/ankle, and pelvis are more commonly affected. Low-molecular-weight heparin is commonly used to treat VTE in pediatric and adolescent patients.

Prevalence and risk factors for venous thromboembolism in children with sickle cell disease: an administrative database study

“…When comparing our results to other administrative database studies, the rate of VTE in children with SCD was found to be lower than the rate of VTE in pediatric cancer patients (5%), 26 comparable to VTE rate in children with congenital heart disease undergoing cardiac surgery (2.7%), 28 but higher than the VTE rate in children with trauma and lower-extremity fractures (0.05% to 0.2%). 29,30 The current work supports our recent, singleinstitution study, where the cumulative incidence of VTE in children with SCD followed at Nationwide Children's Hospital was estimated to be 2.9%, 16 and it adds to a growing body of literature.…”

Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

“…[6,23,25,29] Pediatric orthopedic postoperative VTE rates range from 0.05-0.1%, similar to our findings of 0.1%. [38][39][40] Orthopedic procedures were not the procedures with the highest VTE rate, but they were among the procedures with the highest overall VTE number (CPT code 22804, posterior arthrodesis of 13 or more vertebral segments, had 10 reported VTE events). However, NSQIP excludes trauma with the exception of isolated long bone fractures.…”

Duplex ultrasound for evaluation of deep venous blood flow in fractured lower extremities

“…Deep venous thrombosis (DVT) is a common disease with potentially serious consequences such as pulmonary embolism (PE). It should be noted that venous thromboembolism (VTE) includes both DVT and PE [ 1 , 2 ]. The incidence of DVT in the general population is between 1.6 and 1.8 per 1.000 per year [ 1 ].…”