Skip to main content

Advertisement

Springer Nature Link
Log in

Venous thromboembolism risk factors in a pediatric trauma population

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

New guidelines have been proposed for venous thromboembolism (VTE) prophylaxis in pediatric trauma patients. This paper seeks to evaluate risk factors associated with VTE that might further guide patient selection for prophylaxis.

Methods

Review of a tertiary children’s academic hospital’s trauma database for VTE events and associated risk factors from 2005 to 2016.

Results

15,306 pediatric trauma patients were identified and reviewed. During this time period there were 6191 admissions (40.4%), of which 20 developed a VTE (0.3%) including two pulmonary emboli. Primary outcome was comparison of risk factors for developing a VTE that were identified in the literature. Age stratification revealed the highest incidence of VTE in children under the age of 2 (0.7%), which increased with CVC placement when compared to children aged 2–12 and 13–15 (0.036 Fisher’s exact test).

Conclusions

VTE after pediatric trauma is rare, and may be more uncommon than previously reported. CVC placement was the strongest predictor of VTE, particularly in infant and toddler patients which can explain their higher overall incidence compared to other pediatric age groups. Identifying high-risk patients is important to optimize screening and prophylaxis of VTE in pediatric trauma patients while minimizing risks of anticoagulation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Raffini L, Huang YS, Witmer C, Feudtner C (2009) Dramatic increase in venous thromboembolism in children’s hospitals in the United States from 2001 to 2007. Pediatrics 124(4):1001–1008

    Article  PubMed  Google Scholar 

  2. Andrew M, David M, Adams M, Ali K, Anderson R, Barnard D et al (1994) Venous thromboembolic complications (VTE) in children: first analyses of the Canadian registry of VTE. Blood 83(5):1251–1257

    PubMed  CAS  Google Scholar 

  3. Takemoto CM, Sohi S, Desai K, Bharaj R, Khanna A, McFarland S et al (2014) Hospital-associated venous thromboembolism in children: incidence and clinical characteristics. J Pediatr 164(2):332–338

    Article  PubMed  Google Scholar 

  4. van Ommen CH, Heijboer H, Buller HR, Hirasing RA, Heijmans HS, Peters M (2001) Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands. J Pediatr 139(5):676–681

    Article  PubMed  Google Scholar 

  5. Kerlin BA (2012) Current and future management of pediatric venous thromboembolism. Am J Hematol 87(Suppl 1):S68–S74

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Goudie A, Dynan L, Brady PW, Fieldston E, Brilli RJ, Walsh KE (2015) Costs of venous thromboembolism, catheter-associated urinary tract infection, and pressure ulcer. Pediatrics 136(3):432–439

    Article  PubMed  Google Scholar 

  7. Malec L, Young G (2017) treatment of venous thromboembolism in pediatric patients. Front Pediatr 5:26

    Article  PubMed  PubMed Central  Google Scholar 

  8. Van Arendonk KJ, Schneider EB, Haider AH, Colombani PM, Stewart FD, Haut ER (2013) Venous thromboembolism after trauma: when do children become adults? JAMA Surg 148(12):1123–1130

    Article  PubMed  Google Scholar 

  9. Allen CJ, Murray CR, Meizoso JP, Ray JJ, Neville HL, Schulman CI et al (2016) Risk factors for venous thromboembolism after pediatric trauma. J Pediatr Surg 51(1):168–171

    Article  PubMed  Google Scholar 

  10. Yen J, Van Arendonk KJ, Streiff MB, McNamara L, Stewart FD, Conner KG et al (2016) Risk factors for venous thromboembolism in pediatric trauma patients and validation of a novel scoring system: the risk of clots in kids with trauma score. Pediatr Crit Care Med 17(5):391–399

    Article  PubMed  PubMed Central  Google Scholar 

  11. Vavilala MS, Nathens AB, Jurkovich GJ, Mackenzie E, Rivara FP (2002) Risk factors for venous thromboembolism in pediatric trauma. J Trauma 52(5):922–927

    PubMed  Google Scholar 

  12. Hanson SJ, Punzalan RC, Arca MJ, Simpson P, Christensen MA, Hanson SK et al (2012) Effectiveness of clinical guidelines for deep vein thrombosis prophylaxis in reducing the incidence of venous thromboembolism in critically ill children after trauma. J Trauma Acute Care Surg 72(5):1292–1297

    Article  PubMed  Google Scholar 

  13. Mahajerin A, Petty JK, Hanson SJ, Thompson AJ, O’Brien SH, Streck CJ et al (2017) Prophylaxis against venous thromboembolism in pediatric trauma: a practice management guideline from the eastern association for the surgery of trauma and the pediatric trauma society. J Trauma Acute Care Surg 82(3):627–636

    Article  PubMed  Google Scholar 

  14. Geerts W (2014) Central venous catheter-related thrombosis. Hematol Am Soc Hematol Educ Program 2014(1):306–311

    Article  Google Scholar 

Download references

Acknowledgements

Jeffrey Tomasek and the Center for Translational Research (CeTIR) for their assistance in compiling and maintaining this database that this study was based on.

Funding

No funding was provided for this study.

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, McGovern Medical School at University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 5230, Houston, TX, 77030, USA

    Louis A. Carrillo, Akshita Kumar, Matthew T. Harting & Charles S. Cox Jr

  2. Department of Pediatrics, McGovern Medical School at University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 5230, Houston, TX, 77030, USA

    Claudia Pedroza

Authors
  1. Louis A. Carrillo
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Akshita Kumar
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Matthew T. Harting
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Claudia Pedroza
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Charles S. Cox Jr
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Louis A. Carrillo.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived after review by IRB due to retrospective, anonymous and minimal risk nature of this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carrillo, L.A., Kumar, A., Harting, M.T. et al. Venous thromboembolism risk factors in a pediatric trauma population. Pediatr Surg Int 35, 487–493 (2019). https://doi.org/10.1007/s00383-018-4418-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-018-4418-y

Keywords