2 results
Risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation
- Christie M. Atchison, Ernest Amankwah, Jean Wilhelm, Shilpa Arlikar, Brian R. Branchford, Arabela Stock, Michael Streiff, Clifford Takemoto, Irmel Ayala, Allen Everett, Gary Stapleton, Marshall L. Jacobs, Jeffrey P. Jacobs, Neil A. Goldenberg
-
- Journal:
- Cardiology in the Young / Volume 28 / Issue 2 / February 2018
- Published online by Cambridge University Press:
- 08 November 2017, pp. 234-242
-
- Article
- Export citation
-
Background
Paediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children’s hospitals.
ObjectiveThe aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.
MethodsWe conducted a retrospective, case–control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children’s Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression.
ResultsAmong 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06–31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13–160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13–47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three factors had a markedly increased post-test probability of having hospital-associated venous thromboembolism.
ConclusionMajor infection, infancy, and central venous catheterisation are independent risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or cardiac catheter-based intervention, which, in combination, define a high-risk group for hospital-associated venous thromboembolism.
Chapter 16 - Prevention of VTE in Children
- from Section 2 - Special considerations in pediatric patients
-
- By Brian R. Branchford, University of Colorado, Leslie Raffini, University of Pennsylvania Perlman School of Medicine
- Edited by Neil A. Goldenberg, The Johns Hopkins University School of Medicine, Marilyn J. Manco-Johnson
-
- Book:
- Pediatric Thrombotic Disorders
- Published online:
- 18 December 2014
- Print publication:
- 08 January 2015, pp 207-218
-
- Chapter
- Export citation
-
Summary
Introduction
In-hospital venous thromboembolism (VTE) represents a significant, yet preventable, public health burden, which was recognized in 2008 by the USA Surgeon General’s Call-to-Action [1]. Prophylactic anticoagulation for VTE prevention has been proven to be safe and effective, and has become standard care in hospitalized adults [2,3]. As providers become increasingly aware of the growing problem of VTE in hospitalized children, attention is starting to focus on prevention in this population.
The available data regarding utility and safety of primary prophylaxis is sparse, likely due to the relative infrequency of VTE in children compared to their adult counterparts. Since high-quality evidence in this area is lacking, clinical care is often formulated by expert consensus and extrapolation from adult studies. Two important considerations are clinician awareness of in-hospital VTE, and risk-stratified approaches to prevent unnecessary exposure of low-risk patients to potentially serious side effects. While this is an area expected to evolve greatly, this chapter provides a contemporary review of pertinent background information, risk factors for in-hospital VTE development, and existing recommendations for pharmacologic and non-pharmacologic VTE prophylaxis in children.
Although the incidence of in-hospital VTE is considerably lower in children than adults, it is an increasing problem particularly in pediatric tertiary care hospitals, with potential for severe consequences [4]. Possible explanations for the rising incidence include advances in tertiary care, prolonged survival of medically complex patients, increased utilization of central venous access devices (CVADs), improved imaging sensitivity, and increased awareness. Of children with VTE, 16% to 20% have objectively confirmed pulmonary embolism (PE) [5], and retrospective data from the Hospital for Sick Children indicates a VTE-specific mortality rate of 9% among pediatric PE cases [6]. The risks of long-term pulmonary insufficiency and chronic thromboembolic pulmonary hypertension following PE in children remain undefined.