Deep Venous Thrombosis in the Pediatric Trauma Population: An Unusual Event: Report of Three Cases

Grandas, Oscar H.; Klar, Melinda; Goldman, Mitchell H.; Filston, Howard C.

doi:10.1177/000313480006600309

Cited by 37 publications

(1 citation statement)

References 29 publications

(9 reference statements)

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“…Conversely, in another study utilizing the Kid’s Inpatient Database (KID), the incidence of VTE in pediatric orthopaedic trauma patients was 0.68%. However, incidence of VTE in pediatric patients with isolated fractures of the lower-limbs was 0.25%, compared to 0.32% in patients with pelvic injuries 192 . In another study, Greenwald et al 12 , found that over a 20-year period the incidence of DVT in patients with pelvic and femoral fractures was 0.17%.…”

Section: - What Pediatric Procedures Require Routine Administration O...mentioning

confidence: 86%

Recommendations from the ICM-VTE: Pediatric

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Pediatric Delegates* 1 -Are the risk factors for VTE following orthopaedic procedures different between children and adults?Response/Recommendation: Many risk factors for venous thromboembolism (VTE) in pediatric orthopaedic patients are similar to those in adults. These include older age (adolescents), trauma, malignancy, certain infections, clotting disorders and a personal or family history of VTE. However, certain VTE risk factors reported in adult literature (e.g., smoking) may be less prevalent in children, and vice versa (e.g., congenital thrombophilia).Strength of Recommendation: Moderate.Delegates vote: Agree 100.00% Disagree 0.00% Abstain 0.00% (Unanimous Strong Consensus).Rationale: VTE is a common complication in adults undergoing orthopaedic surgery, and the risk factors for this condition are well established. In contrast, VTE is extremely rare in pediatric orthopaedic patients 1 . The incidence of VTE has been reported at 0.0515% for pediatric patients admitted following elective orthopaedic procedures 2 . The incidence rises to 0.10% when non-elective procedures are included 3 , and peaks at 0.68% in trauma patients 4,5 .Epidemiologic data has demonstrated that the incidence of pediatric VTE is bimodal, with the highest incidence rates in infants and adolescents 6 . Pediatric patient populations with certain conditions are at an increased risk for VTE. These conditions include: congenital heart disease, nephrotic syndrome, prior splenectomy in patients with hemolytic anemia, colectomy in patients with inflammatory bowel disease, congenital thrombophilia and other genetic or metabolic diseases 7 . Catheter-related thrombosis is the single most common cause of pediatric VTE [8][9][10] . Central venous catheters (CVC) may directly damage the vessel wall, increase blood flow turbulence, introduce substances that damage endothelial cells, and contain thrombogenic materials.Due to the complex pathophysiology of pediatric patients, pediatric orthopaedic patients have different risk factors for VTE compared to their non-orthopaedic counterparts 11,12 . Currently, literature suggests that the most common risk factors for VTE in pediatric orthopaedic patients are adolescent age, trauma, infection, cancer, clotting disorders, and a personal or family history of VTE 9,11,13 .Pediatric trauma patients are an identifiable subgroup that is at highest risk of VTE 14 . However, the risk of VTE is not uniform across age groups, with most cases occurring in children aged 10 -15 years (0.1%). In one study, Guzman et al. 4 , found that younger pediatric trauma patients (i.e., under 10 years) had a much lower risk of VTE compared to adolescents aged 13 -15. Moreover, older adolescent patients (> 16 years) physiologically resembled adults, and had similar VTE frequencies to the adult population 4,8,11,[15][16][17][18] .Another specific pediatric orthopaedic population at increased risk of VTE is children with musculoskeletal infections such as osteomyelitis or septic arthritis, especially if the infectin...

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Section: - What Pediatric Procedures Require Routine Administration O...mentioning

confidence: 86%

Recommendations from the ICM-VTE: Pediatric

2022

Journal of Bone and Joint Surgery

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Venous Thromboembolism After Trauma

Arendonk¹,

Schneider²,

Haider³

et al. 2013

JAMA Surg

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Venous thromboembolism prevention in the acutely ill medical patient: A review of the literature and focus on special patient populations

Pendleton¹,

Wheeler²,

Rodgers³

2005

American J Hematol

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Although venous thromboembolism (VTE) is a major public health problem, until recently, our understanding of the risk of VTE in hospitalized acutely ill medical patients has been incomplete. Fortunately, over the past 5 years, there has been an increasing body of literature that highlights the risk of VTE in the nonsurgical patient, identifies unique patient-risk factors, and defines adequate preventative measures. This review highlights the current literature with regard to epidemiology of VTE in hospitalized medical patients and the risk-stratification of these patients and deals with optimal preventative regimens and prevention strategies in special patient groups. Am.

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Deep Venous Thrombosis in the Pediatric Trauma Population: An Unusual Event: Report of Three Cases

Cited by 37 publications

References 29 publications

Recommendations from the ICM-VTE: Pediatric

Recommendations from the ICM-VTE: Pediatric

Venous Thromboembolism After Trauma

Venous thromboembolism prevention in the acutely ill medical patient: A review of the literature and focus on special patient populations

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