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

Abstract

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.

Hospital-associated venous thromboembolism in pediatrics: a systematic review and meta-analysis of risk factors and risk assessment models

“…1 The potential role of age in HA-VTE risk warrants further study. Previous work 1 has shown that neonates and adolescents are most commonly affected by HA-VTE; however, in some of the more recent case-control studies 2,18 age is used as a matching criterion and hence could not be assessed as a potential risk factor. Furthermore, HA-VTE case validation via radiological record review was not employed in a number of studies which suggested age is a risk factor in children.…”

“…In addition, age was not found to be a risk factor in a meta-analysis. However, age, particularly adolescents and neonates, had been shown to be a risk factor in some individual case-control studies, 2,18 and as noted below, adolescents and neonates were the most common age groups represented in non-case-control studies. Lastly, we could not conduct any quantitative analyses for publication bias in risk factors among case-control studies because of the paucity of studies available for each risk factor.…”

“…23 Our meta-analysis helps to confirm previous singleinstitution work to define risk of individual pediatric patients with risk-assessment models. 2,18,21 A recent study by Atchison et al, 24 published after the date range for this review, demonstrated independent risk through multivariate analyses for CVC (5 points), infection (2 points), and LOS ≥4 days (1 point) specifically in non-critically ill children. The risk score demonstrated that with 8, 7, or ≤6 points, the risk of HA-VTE was 12.5%, 1.1%, and 0.1%, respectively.…”

“…In a single institution case-control study, Branchford et al 18 demonstrated statistically significant independent risk for mechanical ventilation, systemic infection, and hospital stay ≥5 days and that this combination in a risk-model yielded a posttest probability of 3.6% for HA-VTE development. By contrast, Sharathkumar et al 2 found six statistically independent risk factors, with associated "points" determined from the β coefficient from a logistic regression model: immobilization (3 points), LOS ≥7 days (2 points), oral contraceptive pills (2 points), CVC (1 point), bacteremia (1 point), and direct admission to critical care (0.5 points).…”

Risk of venous thromboembolism in children after general surgery

“…Previous studies reporting the occurrence of VTE in the children have concentrated on the overall occurrence during hospitalisation and have not reported how the risk of VTE alters with time following hospitalisation with the majority of studies reporting in-patient data only [5][6][7]24]. A single centre retrospective study of hospital associated VTE reported that 18% of patients with an admission for VTE had undergone a general surgical or trauma related surgical procedure in the three months prior to admission with VTE [6].…”