Recommendations for venous thromboembolism prophylaxis in pediatric trauma patients

Hanson, Sheila J.; Faustino, E. Vincent S.; Mahajerin, Arash; O’Brien, Sarah H.; Streck, Christian J.; Thompson, A. Jill; Petrillo, Toni; Petty, John K.

doi:10.1097/ta.0000000000000962

Cited by 25 publications

(35 citation statements)

References 24 publications

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“…In total, 21 of 117 very high risk patients received prophylaxis starting median (IQR) hospital day 6 (3-8); 19/21 were screened in compliance with the protocol and none developed VTE. These patients were median (IQR) age 12 (14)(15)(16) Area under the receiver operating characteristic curve = 0.9; Hosmer-Lemeshow GOF test = NS; variance inflation factor less than 10.…”

Section: Long-term Follow-upmentioning

confidence: 99%

“…Information regarding chemical prophylaxis or screening protocols in injured children is even more limited. As a result, there is wide variation in the field of pediatric trauma regarding VTE practices, and expert consensus is limited regarding risk factors, indications and utilization of prophylaxis, and bleeding risks …”

Section: Introductionmentioning

confidence: 99%

“…As a result, there is wide variation in the field of pediatric trauma regarding VTE practices, and expert consensus is limited regarding risk factors, indications and utilization of prophylaxis, and bleeding risks. 16 Little is known regarding the timing of and contributors to VTE development, complications of anticoagulation, and long-term outcomes of VTE in a critically injured pediatric population. The aim of this study is to address these knowledge deficits and describe our 10-year experience with VTE in children admitted to the intensive care unit (ICU).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Venous thromboembolism in pediatric trauma patients: Ten‐year experience and long‐term follow‐up in a tertiary care center

Leeper

Vissa

Cooper

et al. 2017

Pediatric Blood & Cancer

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Section: Long-term Follow-upmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Venous thromboembolism in pediatric trauma patients: Ten‐year experience and long‐term follow‐up in a tertiary care center

Leeper

Vissa

Cooper

et al. 2017

Pediatric Blood & Cancer

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“…Published pediatric guidelines are based on weak evidence and recommend against the use of pharmacologic prophylaxis except in children with cyanotic congenital heart disease, dilated cardiomyopathy, cavopulmonary anastomosis, end-stage renal disease, and primary pulmonary hypertension (24). A recently published consensus of experts in regards to pediatric trauma recommended against prophylaxis in children <12 years of age and gave a strong recommendation for pharmacologic prophylaxis in patients with a history of VTE, while a weak recommendation for patients with CVCs (25). Given the lack of data, it is not surprising that there is a wide variation in thromboprophylactic practices in critically ill children as shown in the PROTRACT study (26).…”

Section: Prevention Of Vte In Critically Ill or Injured Childrenmentioning

confidence: 99%

Venous Thromboembolism in Critical Illness and Trauma: Pediatric Perspectives

Chima

Hanson

2017

Front. Pediatr.

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Critically ill children and those sustaining severe traumatic injuries are at higher risk for developing venous thromboembolism (VTE) than other hospitalized children. Multiple factors including the need for central venous catheters, immobility, surgical procedures, malignancy, and dysregulated inflammatory state confer this increased risk. As well as being at higher risk of VTE, this population is frequently at an increased risk of bleeding, making the decision of prophylactic anticoagulation even more nuanced. The use of pharmacologic and mechanical prophylaxis remains variable in this high-risk cohort. VTE pharmacologic prophylaxis is an accepted practice in adult trauma and intensive care to prevent VTE development and associated morbidity, but it is not standardized in critically ill or injured children. Given the lack of pediatric specific guidelines, prevention strategies are variably extrapolated from the successful use of mechanical and pharmacologic prophylaxis in adults, despite the differences in developmental hemostasis and thrombosis risk between children and adults. Whether the burden of VTE can be reduced in the pediatric critically ill or injured population is not known given the lack of robust data. There are no trials in children showing efficacy of mechanical compression devices or prophylactic anticoagulation in reducing the rate of VTE. Risk stratification using clinical factors has been shown to identify those at highest risk for VTE and allows targeted prophylaxis. It remains unproven if such a strategy will mitigate the risk of VTE and its potential sequelae.

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“…8,23 Patients less than 12 years of age are considered to have a very low risk of developing DVT. 27 However, this consideration is based on either retrospective trauma data or tradition.…”

mentioning

confidence: 99%

Risk of deep venous thrombosis in elective neurosurgical procedures: a prospective, Doppler ultrasound–based study in children 12 years of age or younger

Scherer¹,

White²,

Shaikh³

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe risk of venous thromboembolism (VTE) from deep venous thrombosis (DVT) is significant in neurosurgical patients. VTE is considered a leading cause of preventable hospital deaths and preventing DVT is a closely monitored quality metric, often tied to accreditation, hospital ratings, and reimbursement. Adult protocols include prophylaxis with anticoagulant medications. Children’s hospitals may adopt adult protocols, although the incidence of DVT and the risk or efficacy of treatment is not well defined. The incidence of DVT in children is likely less than in adults, although there is very little prospectively collected information. Most consider the risk of DVT to be extremely low in children 12 years of age or younger. However, this consideration is based on tradition and retrospective reviews of trauma databases. In this study, the authors prospectively evaluated pediatric patients undergoing a variety of elective neurosurgical procedures and performed Doppler ultrasound studies before and after surgery.METHODSA total of 100 patients were prospectively enrolled in this study. All of the patients were between the ages of 1 month and 12 years and were undergoing elective neurosurgical procedures. The 91 patients who completed the protocol received a bilateral lower-extremity Doppler ultrasound examination within 48 hours prior to surgery. Patients did not receive either medical or mechanical DVT prophylaxis during or after surgery. The ultrasound examination was repeated within 72 hours after surgery. An independent, board-certified radiologist evaluated all sonograms. We prospectively collected data, including potential risk factors, details of surgery, and details of the clinical course. All patients were followed clinically for at least 1 year.RESULTSThere was no clinical or ultrasound evidence of DVT or VTE in any of the 91 patients. There was no clinical evidence of VTE in the 9 patients who did not complete the protocol.CONCLUSIONSIn this prospective study, no DVTs were found in 91 patients evaluated by ultrasound and 9 patients followed clinically. While the study is underpowered to give a definitive incidence, the data suggest that the risk of DVT and VTE is very low in children undergoing elective neurosurgical procedures. Prophylactic protocols designed for adults may not apply to pediatric patients.Clinical trial registration no.: NCT02037607 (clinicaltrials.gov)

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Recommendations for venous thromboembolism prophylaxis in pediatric trauma patients

Cited by 25 publications

References 24 publications

Venous thromboembolism in pediatric trauma patients: Ten‐year experience and long‐term follow‐up in a tertiary care center

Venous thromboembolism in pediatric trauma patients: Ten‐year experience and long‐term follow‐up in a tertiary care center

Venous Thromboembolism in Critical Illness and Trauma: Pediatric Perspectives

Risk of deep venous thrombosis in elective neurosurgical procedures: a prospective, Doppler ultrasound–based study in children 12 years of age or younger

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