Pediatric venous thromboembolism in relation to adults

Spentzouris, Georgios; Scriven, Richard J.; Lee, Thomas K.; Labropoulos, Nicos

doi:10.1016/j.jvs.2011.07.047

Cited by 73 publications

(66 citation statements)

References 111 publications

(129 reference statements)

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“…1–10 In contrast to adult populations in which the proportion of VTE considered to be “idiopathic” is estimated to be 30–40%, the incidence of “idiopathic” VTE in children is much lower, estimated to be between 2.0 and 12.6%. 1, 6, 11–13 Approximately 90–95% of pediatric VTE are associated with risk factors that include: a central venous catheter. 1, 2, 7 , malignancy, underlying chronic conditions, infection, heritable prothrombotic disorders, age less than one or greater than 13 years, trauma, and operative procedures.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of Deep Vein Thrombosis and Pulmonary Embolism in the Elective Pediatric Orthopaedic Patient

Georgopoulos¹,

Hotchkiss

McNair

et al. 2016

Journal of Pediatric Orthopaedics

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Background Although venous thromboembolism has been well studied in the pediatric trauma population, rates of VTE associated with elective pediatric orthopaedic procedures have not been addressed in current literature. The purpose of this retrospective study was to identify the incidence of venous thromboembolism (VTE) in the elective pediatric orthopaedic surgical population and delineate subsets of this population at greatest risk. This study may provide valuable data to begin the process of resolving the controversy surrounding DVT prophylaxis in the pediatric orthopaedic population. Methods The Pediatric Health Information System (PHIS) was queried for patients admitted on an ambulatory or inpatient basis aged <18 years from 1/2006 to 3/2011 during which an elective orthopaedic surgery was the principal procedure performed. Patients with diagnoses or procedures related to infection, trauma, malignancy, or coagulopathies were excluded. Patients admitted through the emergency department (ED) or whose orthopedic procedure was not performed on the admission date were excluded. Age, gender, ethnicity, race, admission year, and all procedures/diagnoses were recorded. The presence of VTE at the index admission or any subsequent readmission within 90 days was recorded. All criteria were coded using ICD-9-CM codes. Generalized logistic regression analyses were used to identify factors related to VTE. Results 143,808 admissions (117,676 patients) matched the inclusion criteria. 33 had a VTE during the index admission with an additional 41 at subsequent readmissions, for a total incidence of 0.0515% by admission and 0.0629% by patient. In the multivariable model, variables significantly [p<0.05] related to VTE included increasing age, admission type, diagnosis of metabolic conditions, obesity, and/or syndromes, and complications of implanted devices and/or surgical procedures. No procedure variables were significantly related to VTE in the multivariable model. Conclusions The incidence of VTE in this cohort of pediatric patients undergoing elective orthopaedic surgery was 0.0515%. In children, underlying diagnosis appears to be a stronger predictor of VTE than procedures performed. Diagnosis with a metabolic condition, syndrome, and/or obesity, complications of implanted devices and/or surgical procedures, older age, and admission as an inpatient were significantly related to the development of a VTE. Level of Evidence Level II; Retrospective prognostic study

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Section: Introductionmentioning

confidence: 99%

“…1, 2, 7 , malignancy, underlying chronic conditions, infection, heritable prothrombotic disorders, age less than one or greater than 13 years, trauma, and operative procedures. 13–15 …”

Section: Introductionmentioning

confidence: 99%

Incidence of Deep Vein Thrombosis and Pulmonary Embolism in the Elective Pediatric Orthopaedic Patient

Georgopoulos¹,

Hotchkiss

McNair

et al. 2016

Journal of Pediatric Orthopaedics

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“…Additionally, he had external risk factors, having had an appendectomy two weeks before the diagnosis of DVT and subsequent bed rest plus infection. In comparison to adults, where up to 50% of the first VTE episodes have an idiopathic underlying condition, VTE in children has a multifactorial pathogenesis, and almost 90% of these cases have at least two risk factors for thrombosis at the time of the event (16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

Serratia marcescens Sepsis in a Child with Deep Venous Thrombosis – A Case Report

Armean¹,

Duicu

Aldea

et al. 2018

The Journal of Critical Care Medicine

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“…Symptomatic VTE is rare in children, affecting only about 0.7 per 100 000 children [1]. In the population as a whole, the overall incidence of first-time VTE is 100 persons per 100 000 annually, and occurrence of the condition rises substantially with increasing age [2].…”

Section: Introductionmentioning

confidence: 99%

Effort Thrombosis (Paget-Schroetter Syndrome) in a 16-Year-Old Male

2014

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Patient: Male, 16Final Diagnosis: Effort thrombosis (Paget-Schroetter Sydnrome)Symptoms: Swollen armsMedication: —Clinical Procedure: —Specialty: Metabolic Disorders and DiabeticsObjective:Rare diseaseBackground:Thrombotic events in otherwise healthy pediatric patients are rare. In patients presenting with limb swelling, thrombosis must be considered in the differential diagnosis. In pediatric patients with thrombosis, there has been wide variability in the rates of associated thrombophilia. Many pediatric patients may instead have other contributors such as venous catheters or physical activity.Case Report:We present a case of bilateral upper extremity deep venous thrombi in a previously healthy 16-year-old male. The patient presented with swelling and pain in both arms after several days of weight-bearing exercise. Following emergency department evaluation with ultrasound and laboratory testing, the patient was diagnosed with effort thrombosis – also known as Paget-Schroetter syndrome – and rhabdomyolysis.Conclusions:This case of Paget-Schroetter syndrome is distinguished by elevation in creatine kinase and transaminases. While these findings can be due to physical exertion and effort, effort thrombosis is not classically associated with laboratory abnormalities except an elevated D-dimer. The significance of these laboratory test result abnormalities remains unclear. Given the rarity of effort thrombosis, further epidemiological study is warranted to determine if these laboratory findings are seen in other cases, and, if so, what implications they may have for management and prognosis.

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Pediatric venous thromboembolism in relation to adults

Cited by 73 publications

References 111 publications

Incidence of Deep Vein Thrombosis and Pulmonary Embolism in the Elective Pediatric Orthopaedic Patient

Incidence of Deep Vein Thrombosis and Pulmonary Embolism in the Elective Pediatric Orthopaedic Patient

Serratia marcescens Sepsis in a Child with Deep Venous Thrombosis – A Case Report

Effort Thrombosis (Paget-Schroetter Syndrome) in a 16-Year-Old Male

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