Risk Factors for Venous Thromboembolic Events in Children With Acute Musculoskeletal Infections

Abstract

Background and Objectives: Venous thromboembolic events (VTE) complicate acute hematogenous musculoskeletal infections (MSKIs) among hospitalized children. However, there is limited guidance for which specific MSKI patients are at the greatest VTE risk. This study aimed to identify VTE risk factors for children hospitalized with MSKIs. Methods: A retrospective chart review was performed of children hospitalized with MSKIs at a single quaternary care pediatric hospital during a 9-year period. Patients with chronic MSKIs, non-hematogenous infections, or significant contributing comorbidities were excluded. Demographic and clinical characteristics were compared between patients with and without VTE using forward stepwise conditional multivariable logistic regression to identify VTE risk factors. Results: Among 335 included patients, 7 (2.1%) developed a VTE. There was no difference in age, sex, or obesity rates for those with or without VTE. Patients with methicillin-resistant Staphylococcus aureus (MRSA) infections and/or critical illness were more likely to develop a VTE with summative adjusted odds ratios of 31.7 and 26.4, respectively. In addition, patients with VTEs had longer hospitalizations (median 4.7 vs. 12.8 d, P<0.001), longer courses of intravenous antimicrobials (median 3.7 vs. 13.5 d, P=0.001), and longer time to fever resolution (median 25.7 vs. 162 h, P=0.004). Conclusions: VTE prevalence among children with acute MSKIs is low. MRSA infection and critical illness significantly increase the risk for VTE development in these patients. Future prospective studies are needed to determine if VTEs in high-risk MSKI patients can be prevented.

What’s New in Pediatric Orthopaedics

“…Although the occurrence of venous thromboembolism in children is low, those with illness requiring critical support (odds ratio [OR], 26.4) and those with methicillin-resistant Staphylococcus aureus (OR, 31.7) were more likely to develop venous thromboembolism, so these children should undergo evaluation for thromboses. Children with venous thromboembolism also had longer hospital stays, courses of intravenous antibiotics, and time to fever resolution 14 .…”