Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: An increasing population at risk

Sandoval, John A.; Sheehan, Michael P.; Stonerock, Charles E.; Shafique, Shoaib; Rescorla, Frederick J.; Dalsing, Michael C.

doi:10.1016/j.jvs.2007.11.054

Cited by 151 publications

(121 citation statements)

References 34 publications

(37 reference statements)

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“…13 By contrast, in a retrospective analysis of the Riley Children's Hospital experience, Sandoval and colleagues observed no consistent trend of increasing VTE risk with age, but rather a bimodal distribution of age with respect to hospital-acquired DVT, with peaks in infancy and adolescence. 14 In one of the only prospective studies of in-hospital DVT, Rohrer and colleagues observed one case of inhospital DVT in 59 at-risk children (defined by the presence of two risk factors, including surgery, trauma, immobility, stroke, cancer, sepsis, femoral venous catheterization, prior VTE, and known thrombophilia), from among 1,779 consecutive hospitalized children over a 6-month period at the University of Massachusetts Medical Center. 15 This finding emphasizes the need for further risk-stratification (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…We employed a similar validation criteria approach to Sandoval and colleagues, 14 but further evaluated each admission record for the presence of signs and symptoms (unilateral limb pain/swelling) compatible with limb DVT, in order to exclude pre-hospital DVT episodes in which Table 3. Sensitivity, specificity, and pre-test probability to post-test probability changes for the risk factor model in all hospitalized patients and patients in the PICU.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for in-hospital venous thromboembolism in children: a case-control study employing diagnostic validation

Branchford¹,

Mourani²,

Bajaj³

et al. 2011

Haematologica

100

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BackgroundStudies evaluating risk factors for in-hospital venous thromboembolism in children are limited by quality assurance of case definition and/or lack of controlled comparison. The objective of this study is to determine risk factors for the development of in-hospital venous thromboembolism in children. Design and MethodsIn a case-control study at The Children's Hospital, Colorado, from 1 st January 2003 to 31 st December 2009 we employed diagnostic validation methods to determine pediatric in-hospital venous thromboembolism risk factors. Clinical data on putative risk factors were retrospectively collected from medical records of children with International Classification of Diseases, 9th edition codes of venous thromboembolism at discharge, in whom radiological reports confirmed venous thromboembolism and no signs/symptoms of venous thromboembolism were noted on admission. ResultsWe verified 78 cases of in-hospital venous thromboembolism, yielding an average incidence of 5 per 10,000 hospitalized children per year. Logistical regression analyses revealed that mechanical ventilation, systemic infection, and hospitalization duration of five days or over were statistically significant, independent risk factors for in-hospital venous thromboembolism (OR=3. ConclusionsThese data indicate that risk of in-hospital venous thromboembolism in children with this risk factor combination may exceed that of hospitalized adults in whom prophylactic anticoagulation is indicated. Substantiation of these findings via multicenter studies could provide the basis for future risk-stratified randomized control trials of pediatric venous thromboembolism prevention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors for in-hospital venous thromboembolism in children: a case-control study employing diagnostic validation

Branchford¹,

Mourani²,

Bajaj³

et al. 2011

Haematologica

100

View full text Add to dashboard Cite

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“…Other pediatric research [8][9][10][11] described annual incidence rates of 0.07 to 0.14 per 10 000 children with rates between 4.9 and 8 per 10 000 admissions to a pediatric hospital and 24 per 10 000 admissions to a neonatal intensive care unit. More recent estimates T hromboembolic events have historically been considered an adult phenomenon.…”

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confidence: 99%

Early Recognition of Pediatric Venous Thromboembolism: A Risk-Assessment Tool

Prentiss

2012

American Journal of Critical Care

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BackgroundThe incidence of venous thromboembolism in children has increased dramatically, with most cases occurring in children with cancer, surgery, trauma, congenital heart disease, and systemic lupus erythematosus. Early assessment of risk factors present in children would minimize morbidity and mortality from these events. Objectives To evaluate the reliability and validity of a tool for assessing risk for venous thromboembolism in children. Methods The tool was developed after a review of the literature with assessment of content validity by a multidisciplinary team of experts. Patients' charts were reviewed retrospectively to establish reliability and validity of the tool. A P value less than .05 was considered statistically significant. Results Thirty-five charts were assessed for tool validity and were found to be statistically significant for all 3 risk score assessment categories. Logistic regression was used to assess 1001 patients' charts for internal consistency, which was found to be high (χ 2 5 [n = 1001] = 100.6, P < .001). Results indicated that most patients at risk for venous thromboembolism were between the ages of 13 and 17 years, with females having more than 7 times greater risk than males. Conclusions Descriptive statistics show that the assessment tool displays strong reliability and validity. Results validated a significant relationship between the risk score and the incidence of venous thromboembolism. Findings suggest that use of the assessment tool could significantly reduce adverse outcomes associated with venous thromboembolism in children. Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Identify factors associated with increased risk for development of venous thromboembolism (VTE) in pediatric patients. 2. Describe study findings regarding the relationship between the total score on the risk assessment tool and the incidence of VTE in pediatric patients. 3. Discuss opportunities for future research related to VTE in pediatric patients.

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“…They often suffer complications, such as sepsis, which further heightens the risk of VTE. The reported incidence of VTE in hospitalised children has also increased because of greater recognition that thromboses are a significant risk in critically ill children (Tormene et al, 2006;Sandoval et al, 2008).…”

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confidence: 99%

Aspects of anticoagulation in children

Payne

2010

Br J Haematol

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SummaryThe number of children receiving anticoagulation is increasing. Thromboembolic events are associated with significant risk of morbidity and mortality although the optimal management of asymptomatic events remains unclear. Specific challenges in paediatrics include the diagnosis of thrombosis, delivery and monitoring of anticoagulation in a wide range of ages from neonates through to adolescents. The development of the haemostatic system as children age results in changing pathophysiology of thrombosis and response to anticoagulation agents. Although registry and observational studies have provided vital information, specific paediatric, prospective anticoagulation studies have been few and limited in design. The result is that much of current practice is extrapolated from adult studies. Traditional anticoagulants have significant limitations. Both heparin and warfarin are in widespread use but many fundamental questions regarding dose, therapeutic range, efficacy and optimum duration have not been fully answered. Alternative agents, such as direct thrombin inhibitors and the selective anti-factor Xa inhibitor fondaparinux, may have advantages for children. Clinical trials in adults and preliminary data in children are promising but caution should be applied until specific paediatric studies have demonstrated safety and efficacy.

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Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: An increasing population at risk

Cited by 151 publications

References 34 publications

Risk factors for in-hospital venous thromboembolism in children: a case-control study employing diagnostic validation

Risk factors for in-hospital venous thromboembolism in children: a case-control study employing diagnostic validation

Early Recognition of Pediatric Venous Thromboembolism: A Risk-Assessment Tool

Aspects of anticoagulation in children

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