A multi-institutional registry of pediatric hospital-acquired thrombosis cases: The Children's Hospital-Acquired Thrombosis (CHAT) project

Jaffray, Julie; Mahajerin, Arash; Young, Guy; Goldenberg, Neil A.; Ji, Lingyun; Sposto, Richard; Stillings, Amy; Krava, Emily; Branchford, Brian R.

doi:10.1016/j.thromres.2017.11.019

Cited by 65 publications

(73 citation statements)

References 24 publications

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“…Furthermore, length of hospital stay cannot be accurately predicted at the time of admission. Thus, the CHAT Consortium is developing a de novo RAM for pediatric HA‐VTE using putative predictors that are present within a day of admission to the hospital . The multicenter nature of the CHAT Consortium should minimize the effect of local practices on the risk of HA‐VTE.…”

Section: Discussionmentioning

confidence: 99%

“…The pediatric RAMs for HA‐VTE were identified from a prior review . We used randomly selected subjects from the Children's Hospital‐Acquired Thrombosis (CHAT) Registry, which contains data from eight centers: Akron Children's Hospital, Boston Children's Hospital, Children's Hospital Colorado, Children's Hospital Los Angeles, Children's Hospital of Pittsburgh, Children's Mercy Hospital (Kansas City), CHOC Children's Hospital, and the Indiana Hemophilia Treatment Center . The performance of the RAMs was compared in terms of discrimination and calibration .…”

Section: Methodsmentioning

confidence: 99%

“…Subjects included in the CHAT Registry were 0‐21 years old (inclusive) of any gender, race, or ethnicity; were admitted to one of the participating centers between January 2012 and December 2017; and were clinically diagnosed with HA‐VTE . HA‐VTE was defined as a radiographic‐confirmed VTE that was detected after admission to the hospital or within 7 days after discharge from the hospital, whether incident or recurrent.…”

Section: Methodsmentioning

confidence: 99%

“…The CHAT Consortium was previously described in detail. 9 In brief, the CHAT Consortium was originally designed to create a retrospective database, ie, CHAT Registry, of HA-VTE from children admitted to eight tertiary care pediatric centers. Subsequently, a prospective multicenter cohort study has been initiated for prospective validation efforts.…”

Section: Children's Hospital-acquired Thrombosis (Chat) Consortiummentioning

confidence: 99%

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Comparative validation study of risk assessment models for pediatric hospital‐acquired venous thromboembolism

Mahajerin

Jaffray

Branchford

et al. 2020

Journal of Thrombosis and Haemostasis

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Background Risk assessment models (RAMs) have been developed to identify children at high risk of hospital‐acquired venous thromboembolism (HA‐VTE). None have been externally validated nor compared. Objectives The objective was to compare performance of these RAMs by externally validating them using the Children's Hospital‐Acquired Thrombosis (CHAT) Registry, ie, a multicenter database of children with radiographic‐confirmed HA‐VTE and corresponding controls. Patients/Methods Risk assessment models were included if the full logistic regression equation was available and all RAM variables were collected in the CHAT Registry. A random sample of 200 cases and 200 controls was selected. The performance of the RAMs was assessed for discrimination using area under the receiver operating characteristic curves (AUROC), and calibration using plots, slopes, and intercepts, and the Hosmer‐Lemeshow test. Results Three RAMs were included. Each had excellent discrimination with AUROC ≥ 0.85. However, calibration was generally poor, with calibration slopes significantly different from 1 (0.71, P < .001; 1.44, P = .002; 0.68, P < .001), intercepts significantly different from 0 (−1.64, P < .001; −0.62, P < .001; 0.78, P < .001), and Hosmer‐Lemeshow test P < .001 for each. Exceptions included the Arlikar et al and Atchison et al RAMs for pediatric HA‐VTE in non‐intensive care unit (ICU) patients and ICU patients, respectively, despite derivation from ICU and non‐ICU patients, respectively. In these subpopulations, both showed excellent discrimination and good calibration. Conclusion Given the lack of adequate calibration for evaluated RAMs, further investigation and refinement of RAMs for pediatric HA‐VTE is needed prior to application of a RAM in a clinical setting or risk‐stratified clinical trial of primary thromboprophylaxis against HA‐VTE in children.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Children's Hospital-acquired Thrombosis (Chat) Consortiummentioning

confidence: 99%

See 2 more Smart Citations

Comparative validation study of risk assessment models for pediatric hospital‐acquired venous thromboembolism

Mahajerin

Jaffray

Branchford

et al. 2020

Journal of Thrombosis and Haemostasis

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“…The care of children with or at risk for thrombosis requires expertise in management of anticoagulation (and reversal). Coagulationists are called upon to develop anticoagulation policies and procedures and lead hospital‐wide efforts to prevent hospital‐acquired venous thromboembolism and sometimes run a local coagulation laboratory for reliable diagnostics. In addition to the care of patients with bleeding and clotting disorders, coagulationists may lead or participate in Vascular Malformation Clinics and Blood Bank/Transfusion Medicine services.…”

Section: Why Do We Need To Train Clinical Specialists In Hemostasis Amentioning

confidence: 99%

How we approach: Training pediatric coagulationists

Thornburg

Montgomery

Pipe

2019

Pediatric Blood & Cancer

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Unique expertise is required for the care of children, adolescents, and young adults with bleeding and clotting disorders. A number of Hemophilia Treatment Centers have developed pediatric hemostasis and thrombosis fellowship programs to facilitate subspecialty training and recruitment and retention in this field. This manuscript reviews an approach to training pediatric coagulationists including a description of current programs, sample curriculum, funding sources, and expected outcomes.

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FDA approval summary: Dalteparin for the treatment of symptomatic venous thromboembolism in pediatric patients

Merino

Richardson

Reaman

et al. 2020

Pediatric Blood & Cancer

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On May 16, 2019, the U.S. Food and Drug Administration (FDA) approved dalteparin sodium for the treatment of symptomatic venous thromboembolism (VTE) to reduce the risk of recurrence in pediatric patients 1 month of age and older. Approval was primarily based on FDA review of a single-arm trial evaluating dalteparin administered subcutaneous twice daily in 38 pediatric patients with symptomatic VTE. Efficacy was based on the achievement of therapeutic plasma anti-Xa levels. The FDA concluded that dalteparin has efficacy and acceptable safety for pediatric patients.

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A multi-institutional registry of pediatric hospital-acquired thrombosis cases: The Children's Hospital-Acquired Thrombosis (CHAT) project

Cited by 65 publications

References 24 publications

Comparative validation study of risk assessment models for pediatric hospital‐acquired venous thromboembolism

Comparative validation study of risk assessment models for pediatric hospital‐acquired venous thromboembolism

How we approach: Training pediatric coagulationists

FDA approval summary: Dalteparin for the treatment of symptomatic venous thromboembolism in pediatric patients

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