Venous thromboembolism in the setting of pediatric traumatic brain injury

Harris, Dominic A.; Lam, Sandi

doi:10.3171/2014.1.peds13479

Cited by 32 publications

(16 citation statements)

References 27 publications

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“…Algorithms in the published literature and the recommendations of the US Food and Drug Administration's MiniSentinel program for identifying health outcomes of interest from administrative and claims data were used (http:// www.mini-sentinel.org/methods/outcome_identification/ default.aspx). 3,5,6,11,13,15 The rates of cardiac events (0.5% in KID, 0.3% in Peds NSQIP, and 0.4%-2.2% in the literature), stroke/intracranial bleeds (0.4% in KID, 0.5% in Peds NSQIP, and 0.3%-1.2% in the literature), infection (0.2% in KID, 0.8% in Peds NSQIP, and 0%-8% in the literature), wound disruption (0.2% in KID, 0.5% in Peds NSQIP, and 0%-4% in the literature), and seizures (0.7% in KID, 0.8% in Peds NSQIP, and 0%-0.8% in the literature) were low and similar between the 2 data sets. The rates of blood product transfusion (36% in KID and 64% in Peds NSQIP) varied between the 2 data sets.…”

Section: Resultsmentioning

confidence: 99%

“…Hospital data were stratified by the following 6 characteristics: ownership/control, bedsize, teaching status, rural/urban location, region in the US, and status as a freestanding children's hospital. 6 The number of participating states was 44 in 2012 with data from 4179 hospitals. The KID database contains information on 3,195,782 pediatric discharges, which was weighted to represent 6,675,222 national discharges in 2012.…”

Section: Data Source and Statistical Analysis: Kidmentioning

confidence: 99%

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Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database

Lin

Pan

Mayer

et al. 2015

FOC

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OBJECT Research conducted using large administrative data sets has increased in recent decades, but reports on the fidelity and reliability of such data have been mixed. The goal of this project was to compare data from a large, administrative claims data set with a quality improvement registry in order to ascertain similarities and differences in content. METHODS Data on children younger than 12 months with nonsyndromic craniosynostosis who underwent surgery in 2012 were queried in both the Kids’ Inpatient Database (KID) and the American College of Surgeons Pediatric National Surgical Quality Improvement Program (Peds NSQIP). Data from published clinical craniosynostosis surgery series are reported for comparison. RESULTS Among patients younger than 12 months of age, a total of 1765 admissions were identified in KID and 391 in Peds NSQIP in 2012. Only nonsyndromic patients were included. The mean length of stay was 3.2 days in KID and 4 days in Peds NSQIP. The rates of cardiac events (0.5% in KID, 0.3% in Peds NSQIP, and 0.4%-2.2% in the literature), stroke/intracranial bleeds (0.4% in KID, 0.5% in Peds NSQIP, and 0.3%-1.2% in the literature), infection (0.2% in KID, 0.8% in Peds NSQIP, and 0%-8% in the literature), wound disruption (0.2% in KID, 0.5% in Peds NSQIP, 0%-4% in the literature), and seizures (0.7% in KID, 0.8% in Peds NSQIP, 0%-0.8% in the literature) were low and similar between the 2 data sets. The reported rates of blood transfusion (36% in KID, 64% in Peds NSQIP, and 1.7%-100% in the literature) varied between the 2 data sets. CONCLUSIONS Both the KID and Peds NSQIP databases provide large samples of surgical patients, with more cases reported in KID. The rates of complications studied were similar between the 2 data sets, with the exception of blood transfusion events where the retrospective chart review process of Peds NSQIP captured almost double the rate reported in KID.

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Section: Resultsmentioning

confidence: 99%

Section: Data Source and Statistical Analysis: Kidmentioning

confidence: 99%

Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database

Lin

Pan

Mayer

et al. 2015

FOC

Self Cite

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“…Branchford et al reported the odds of HA-VTE increasing by 3% for each additional day beyond 5 days. Pediatric trauma-specific literature has demonstrated daily increases in HA-VTE risk of 2 and 3% for those admitted with traumatic brain injury and general trauma, respectively (37, 38). Future research detailing increases in daily risk in the context of concomitant risk factors and whether risk can also decrease with elimination of other risk factors is lacking but would prove beneficial in understanding how LOS impacts VTE risk.…”

Section: Risk Factorsmentioning

confidence: 99%

Epidemiology and Risk Assessment of Pediatric Venous Thromboembolism

Mahajerin

Croteau

2017

Front. Pediatr.

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The incidence of diagnosed venous thromboembolism (VTE) has been increasing concurrent with advances in technology and medical care that enhance our ability to treat pediatric patients with critical illness or complex multiorgan system dysfunction. Although the overall incidence of VTE is estimated at 0.07–0.49 per 10,000 children, higher rates are observed in specific populations including hospitalized children, those with central venous catheters (CVCs) or patients convalescing from a major surgery. While the absolute number of pediatric VTE events may seem trivial compared to adults, the increasing incidence, associated with increased mortality and morbidity, the availability of novel therapies, and the impact on the cost of care have made investigation of VTE risk factors and prevention strategies a high priority. Many putative risk factors for pediatric VTE have been reported, primarily from single-institution, retrospective studies which lack appropriate methods for verifying independent risk factors. In addition, some risk factors have inconsistent definitions, which vex meta-analyses. CVCs are the most prevalent risk factors but have not consistently been assigned the highest level of risk as defined by odds ratios from retrospective, case–control studies. Few risk-assessment models for hospital-acquired pediatric VTE have been published. Some models focus exclusively on hospitalized pediatric patients, while others target specific populations such as patients with cancer or severe trauma. Multicenter, prospective studies are needed to identify and confirm risk factors in order to create a pediatric risk-assessment tool and optimize preventive measures and reduce unintended harm.

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“…In retrospective studies, risk factors for DVT in children include central venous lines, obesity, mechanical ventilation, preexisting coagulopathies, transfusion, higher Injury Severity Score, sepsis, trauma, malignancy, orthopedic surgery, and cranial surgical procedures. 2,12,27,28,34,49 The authors of a previous ultrasound study in primarily adult neurosurgical patients noted that the majority of perioperative DVTs occurred within 1 week of surgery and that the risk correlated with the duration of surgery. 32 A growing body of literature demonstrates a reduction of VTE in neurosurgical patients with pharmacological prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Risk of deep venous thrombosis in elective neurosurgical procedures: a prospective, Doppler ultrasound–based study in children 12 years of age or younger

Scherer¹,

White²,

Shaikh³

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe risk of venous thromboembolism (VTE) from deep venous thrombosis (DVT) is significant in neurosurgical patients. VTE is considered a leading cause of preventable hospital deaths and preventing DVT is a closely monitored quality metric, often tied to accreditation, hospital ratings, and reimbursement. Adult protocols include prophylaxis with anticoagulant medications. Children’s hospitals may adopt adult protocols, although the incidence of DVT and the risk or efficacy of treatment is not well defined. The incidence of DVT in children is likely less than in adults, although there is very little prospectively collected information. Most consider the risk of DVT to be extremely low in children 12 years of age or younger. However, this consideration is based on tradition and retrospective reviews of trauma databases. In this study, the authors prospectively evaluated pediatric patients undergoing a variety of elective neurosurgical procedures and performed Doppler ultrasound studies before and after surgery.METHODSA total of 100 patients were prospectively enrolled in this study. All of the patients were between the ages of 1 month and 12 years and were undergoing elective neurosurgical procedures. The 91 patients who completed the protocol received a bilateral lower-extremity Doppler ultrasound examination within 48 hours prior to surgery. Patients did not receive either medical or mechanical DVT prophylaxis during or after surgery. The ultrasound examination was repeated within 72 hours after surgery. An independent, board-certified radiologist evaluated all sonograms. We prospectively collected data, including potential risk factors, details of surgery, and details of the clinical course. All patients were followed clinically for at least 1 year.RESULTSThere was no clinical or ultrasound evidence of DVT or VTE in any of the 91 patients. There was no clinical evidence of VTE in the 9 patients who did not complete the protocol.CONCLUSIONSIn this prospective study, no DVTs were found in 91 patients evaluated by ultrasound and 9 patients followed clinically. While the study is underpowered to give a definitive incidence, the data suggest that the risk of DVT and VTE is very low in children undergoing elective neurosurgical procedures. Prophylactic protocols designed for adults may not apply to pediatric patients.Clinical trial registration no.: NCT02037607 (clinicaltrials.gov)

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Venous thromboembolism in the setting of pediatric traumatic brain injury

Cited by 32 publications

References 27 publications

Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database

Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database

Epidemiology and Risk Assessment of Pediatric Venous Thromboembolism

Risk of deep venous thrombosis in elective neurosurgical procedures: a prospective, Doppler ultrasound–based study in children 12 years of age or younger

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