BackgroundPaediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children’s hospitals.ObjectiveThe aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.MethodsWe conducted a retrospective, case–control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children’s Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression.ResultsAmong 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06–31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13–160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13–47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three factors had a markedly increased post-test probability of having hospital-associated venous thromboembolism.ConclusionMajor infection, infancy, and central venous catheterisation are independent risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or cardiac catheter-based intervention, which, in combination, define a high-risk group for hospital-associated venous thromboembolism.
Background: Pediatric hospital-acquired venous thromboembolism (HA-VTE) has dramatically risen in recent years. Children with congenital or acquired heart disease are at particular risk and have not been addressed by recent, novel retrospectively-derived risk scores. Aims: We sought to develop a risk model for HA-VTE in critically-ill children with cardiac disease. Methods: We conducted a retrospective, case-control study of children admitted to the CVICU at All Children's Hospital Johns Hopkins Medicine (St. Petersburg, FL, USA) from January 2006 - April 2013. We identified cases via ICD-9 codes, and employed case validation via review of radiologic records. Two controls were randomly selected for each case. Associations between putative risk factors and HA-VTE were estimated using odds ratios (ORs) and ninety-five percent confidence intervals (95%CIs) from univariate and multivariate logistic regression analyses. Variables with P-values < 0.1 in univariate analyses were included in the multivariate model. A HA-VTE risk score was developed with weighting based on the relative magnitudes of the individual ORs from the multivariate model. Results: After adjustment in a multiple logistic regression, length of stay (LOS) >30 days, cardiac catheterization, and major infection were found to be statistically-significant independent risk factors for HA-VTE in these children. An 8-point risk score was developed in which scores of 0-1, 2-6, and 7-8 yielded HA-VTE risks of < 1%, 1-< 2%, and ≥2%, corresponding to conventional thresholds for instituting no prophylaxis, mechanical prophylaxis, and pharmacological prophylaxis (respectively) in hospitalized adults. Conclusions: LOS >30 days, cardiac catheterization, and major infection are significant independent risk factors for HA-VTE in critically-ill children with cardiac disease leading to the development of a novel HA-VTE risk score in this population. If prospectively validated, this risk score will inform the design of risk-stratified clinical trials of HA-VTE prevention.
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