The Role of Clinically Significant Venous Thromboembolism and Thromboprophylaxis in Pediatric Patients With Pelvic or Femoral Fractures

Greenwald, Lark J.; Yost, Mary; Sponseller, Paul D.; Ziegfeld, Susan; Ain, Michael C.

doi:10.1097/bpo.0b013e31824b2a07

Cited by 31 publications

(32 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding risk factors for VTE, controlling for demographic and surgical variables, compared with patients aged 11–15 years, the present study identifies significantly increased risk of VTE among patients aged 16–18 years (OR=1.892, p<0.001), with children aged 6–10 years at lower risk (OR=0.625, p=0.024). This finding is consistent with previous studies, which suggests that adolescents are at higher risk for VTE 10 17 18 31 33. As an example, a study of hospitalized pediatric patients finds that compared with patients aged 1–4 years, those aged 15–17 years are at more than twice the risk of VTE 7.…”

Section: Discussionsupporting

confidence: 92%

Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events

Mets

McLynn

Grauer

2020

World Jnl Ped Surgery

View full text Add to dashboard Cite

BackgroundAlthough less common in adults, venous thromboembolism (VTE) in children is a highly morbid, preventable adverse event. While VTE has been well studied among pediatric hospitalized and trauma patients, limited work has been done to examine postoperative VTE in children undergoing surgery.MethodsUsing data from National Surgical Quality Improvement Project Pediatric database (NSQIP-P) from 2012 to 2016, a retrospective cohort analysis was performed to determine the incidence of, and risk factors for, VTE in children undergoing surgery. Additionally, the relationships between VTE and other postoperative adverse outcomes were evaluated.ResultsOf 361 384 pediatric surgical patients, 378 (0.10%) were identified as experiencing postoperative VTE. After controlling for patient and surgical factors, we found that American Society of Anesthesiologists (ASA) class of II or greater, aged 16–18 years, non-elective surgery, general surgery (compared with several other surgical specialties), cardiothoracic surgery (compared with general surgery) and longer operative time were significantly associated with VTE in pediatric patients (p<0.001 for each comparison). Furthermore, a majority of adverse events were found to be associated with increased risk of subsequent VTE (p<0.001).ConclusionIn a large pediatric surgical population, an incidence of postoperative VTE of 0.10% was observed. Defined patient and surgical factors, and perioperative adverse events were found to be associated with such VTE events.

show abstract

Section: Discussionsupporting

confidence: 92%

Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events

Mets

McLynn

Grauer

2020

World Jnl Ped Surgery

View full text Add to dashboard Cite

show abstract

“…It is also worth noting, that while pelvic and femur fractures in adults are recognized as a risk factor for VTE, in our study we found that orthopedic injuries or blunt trauma were not independent risks for VTE in pediatric patients. Similarly, other studies in children with trauma did not demonstrate that pelvic and femoral fractures were significant risk factors for VTE(8, 29). …”

Section: Discussionmentioning

confidence: 64%

Risk Factors for Venous Thromboembolism in Pediatric Trauma Patients and Validation of a Novel Scoring System: The Risk of Clots in Kids With Trauma Score*

Yen¹,

Arendonk

Streiff³

et al. 2016

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

OBJECTIVES Identify risk factors for venous thromboembolism (VTE) and develop a VTE risk assessment model for pediatric trauma patients. DESIGN, SETTING, AND PATIENTS We performed a retrospective review of patients 21 years and younger who were hospitalized following traumatic injuries at the John Hopkins level 1 adult and pediatric trauma center (1987-2011). The clinical characteristics of patients with and without VTE were compared, and multivariable logistic regression analysis was used to identify independent risk factors for VTE. Weighted risk assessment scoring systems were developed based on these and previously identified factors from patients in the National Trauma Data Bank (NTDB 2008-2010); the scoring systems were validated in this cohort from Johns Hopkins as well as a cohort of pediatric admissions from the NTDB (2011-2012). MAIN RESULTS Forty-nine of 17,366 pediatric trauma patients (0.28%) were diagnosed with VTE after admission to our trauma center. After adjusting for potential confounders, VTE was independently associated with older age, surgery, blood transfusion, higher Injury Severity Score (ISS), and lower Glasgow Coma Scale (GCS) score. These and additional factors were identified in 402,329 pediatric patients from the NTDB from 2008-2010; independent risk factors from the logistic regression analysis of this NTDB cohort were selected and incorporated into weighted risk assessment scoring systems. Two models were developed and were cross-validated in 2 separate pediatric trauma cohorts: 1) 282,535 patients in the NTDB from 2011 to 2012 2) 17,366 patients from Johns Hopkins. The receiver operator curve using these models in the validation cohorts had area under the curves that ranged 90% to 94%. CONCLUSIONS VTE is infrequent after trauma in pediatric patients. We developed weighted scoring systems to stratify pediatric trauma patients at risk for VTE. These systems may have potential to guide risk-appropriate VTE prophylaxis in children after trauma.

show abstract

“…In their study, more than half of the respondents could recall at least one case of DVT during their career. In a follow-up survey, Sabharwal et al [ 6 ] reported on 46 children who suffered a VTE event as result of either trauma or elective orthopedic surgery. Most VTE events were associated with lower extremity procedures, such as osteotomies and fixation of a long-bone fracture.…”

Section: Discussionmentioning

confidence: 99%

“…Current literature regarding VTE in children with orthopaedic trauma is limited by small cohorts of patients [ 6 ] or survey responses [ 7 , 8 ]. Recently, data on VTE associated with elective orthopaedic procedures has been published [ 9 ], but there is no national data in the USA on VTE events associated with pediatric orthopaedic trauma.…”

Section: Introductionmentioning

confidence: 99%

Pediatric orthopaedic lower extremity trauma and venous thromboembolism

Murphy

Naqvi

Miller

et al. 2015

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

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.

show abstract

The Role of Clinically Significant Venous Thromboembolism and Thromboprophylaxis in Pediatric Patients With Pelvic or Femoral Fractures

Abstract: Level II, retrospective study.

Cited by 31 publications

References 18 publications

Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events

Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events

Risk Factors for Venous Thromboembolism in Pediatric Trauma Patients and Validation of a Novel Scoring System: The Risk of Clots in Kids With Trauma Score*

Pediatric orthopaedic lower extremity trauma and venous thromboembolism

Contact Info

Product

Resources

About