Epidemiology and Risk Assessment of Pediatric Venous Thromboembolism

Mahajerin, Arash; Croteau, Stacy E.

doi:10.3389/fped.2017.00068

Cited by 54 publications

(57 citation statements)

References 57 publications

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“…We conducted a comparative validation study. 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 .…”

Section: Methodsmentioning

confidence: 99%

“…The incidence of venous thromboembolism (VTE) continues to increase in hospitalized children . This increasing incidence is attributed to improved survival of children with chronic conditions, increased use of central venous catheters (CVC) and other life‐saving technologies, improved imaging modalities, and increased awareness of VTE . VTE is associated with acute and chronic morbidities, mortality, and increased health‐care costs .…”

Section: Introductionmentioning

confidence: 99%

“…This increasing incidence is attributed to improved survival of children with chronic conditions, increased use of central venous catheters (CVC) and other life‐saving technologies, improved imaging modalities, and increased awareness of VTE . VTE is associated with acute and chronic morbidities, mortality, and increased health‐care costs . Given these adverse outcomes from VTE, patient safety initiatives are being undertaken to reduce the incidence of hospital‐acquired VTE (HA‐VTE) in children .…”

Section: Introductionmentioning

confidence: 99%

“…Risk assessment models (RAMs) may be used to identify children at high risk of HA‐VTE. A total of six pediatric RAMs for HA‐VTE have been published (Table ) . These RAMs focus on all children, children in non‐intensive care, or children in intensive care.…”

Section: Introductionmentioning

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: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…In contrast to adults with 30-50% idiopathic VTE events, the majority of VTE diagnosed in children are considered to be provoked by risk factors and arise proximal to hospitalisation (van Ommen et al, 2001;Mahajerin & Croteau, 2017;van Ommen & Nowak-G€ ottl, 2017). According to the multifactorial pathogenesis of VTE, most children (~90%) exhibit two or more risk factors for thrombosis at time of the event (Andrew et al, 1994).…”

Section: Risk Factors For Paediatric Vtementioning

confidence: 99%

Advances in predicting venous thromboembolism risk in children

Rühle

Stoll

2017

Br J Haematol

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Paediatric venous thromboembolism (VTE) is a rare disorder but a rising incidence has been observed in recent years, due to improved VTE diagnosis and increased use of central venous catheters in the treatment of severe diseases. Risk assessment strategies are well established for adult patients, however, similar guidelines for paediatric patients are largely lacking. Several risk prediction tools have been reported in recent literature, which make use of established risk factors to assess VTE risk in paediatric subgroups, such as hospitalised children, cancer-diagnosed children and paediatric trauma patients. Although these models suffer several limitations regarding their study size and heterogeneous selection of predictor variables, they offer potential for improving the thromboprophylaxis management in these children. Here, we give an overview on recently reported risk prediction models for paediatric VTE.

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Model-Guided Decision-Making for Thromboprophylaxis and Hospital-Acquired Thromboembolic Events Among Hospitalized Children and Adolescents

Walker,

French,

Moore

et al. 2023

JAMA Netw Open

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ImportanceRates of hospital-acquired venous thromboembolism (HA-VTE) are increasing among pediatric patients. Identifying at-risk patients for whom prophylactic interventions should be considered remains challenging.ObjectiveTo determine whether use of a previously validated HA-VTE prognostic model, together with pediatric hematologist review, could reduce pediatric inpatient rates of HA-VTE.Design, Setting, and ParticipantsThis pragmatic randomized clinical trial was performed from November 2, 2020, through January 31, 2022, at a single-center academic children’s hospital (Monroe Carell Jr Children’s Hospital at Vanderbilt). All pediatric hospital admissions (aged &lt;22 years) under inpatient status were included and randomized.InterventionAll patients had an HA-VTE probability automatically calculated daily, which was visible to the hematology research team for patients in the intervention group. Patients with an elevated risk (predicted probability ≥2.5%) underwent additional medical record review by the research team to determine eligibility for thromboprophylaxis.Main Outcomes and MeasuresThe primary outcome was rate of HA-VTE. Secondary outcomes included rates of prophylactic anticoagulation and anticoagulation-associated bleeding events.ResultsA total of 17 427 hospitalizations met eligibility criteria, were randomized, and were included in the primary analysis: patients had a median (IQR) age of 1.7 (0 to 11.1) years; there were 9143 (52.5%) female patients and 8284 (47.5%) male patients, and there were 445 (2.6%) Asian patients, 2739 (15.9%) Black patients, and 11 752 (67.4%) White patients. The 2 groups were evenly balanced in number (8717 in the intervention group and 8710 in the control group) and patient characteristics. A total of 58 patients (0.7%) in the control group and 77 (0.9%) in the intervention group developed HA-VTE (risk difference: 2.2 per 1000 patients; 95% CI, −0.4 to 4.8 per 1000 patients; P = .10). Recommendations to initiate thromboprophylaxis were accepted by primary clinical teams 25.8% of the time (74 of 287 hospitalizations). Minor bleeding events were rare among patients who received anticoagulation (3 of 74 [4.1%]), and no major bleeding events were observed during the study period. Among patients randomized to the control group, the model exhibited high discrimination accuracy (C statistic, 0.799, 95% CI, 0.725 to 0.856).Conclusions and RelevanceIn this randomized clinical trial of the use of a HA-VTE prognostic model to reduce pediatric inpatient rates of HA-VTE, despite the use of an accurate and validated prognostic model for HA-VTE, there was substantial reluctance by primary clinical teams to initiate thromboprophylaxis as recommended. In this context, rates of HA-VTE between the control and intervention groups were not different. Future research is needed to identify improved strategies for prevention of HA-VTE and to overcome clinician concerns regarding thromboprophylaxis.Trial RegistrationClinicalTrials.gov Identifier: NCT04574895

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Epidemiology and Risk Assessment of Pediatric Venous Thromboembolism

Cited by 54 publications

References 57 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

Advances in predicting venous thromboembolism risk in children

Model-Guided Decision-Making for Thromboprophylaxis and Hospital-Acquired Thromboembolic Events Among Hospitalized Children and Adolescents

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