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Pediatric Venous Thromboembolism Following Trauma: A Review of the National Trauma Data Bank

Saturday, October 20, 2012: 3:10 PM
Versailles Ballroom (Hilton Riverside)
Jeffrey S. Barton, MD, Peter E. Fischer, Samantha J. Underwood, Sanjay Krishnaswami, Martin A. Schreiber and Jennifer M. Watters, Surgery, Oregon Health & Science University, Portland, OR

Purpose While venous thromboembolism (VTE) is rare in pediatric trauma patients, evidence exists that the prevalence of VTE is increasing. Thromboembolic prophylaxis decreases the risk of VTE following trauma, but unlike adult patients children rarely receive routine thromboprophylaxis. The aim of this study was to identify risk factors for VTE in pediatric patients using the American College of Surgeons National Trauma Data Bank (NTDB).

Methods Age 18 and younger patients with injuries and complications recorded were identified from the NTDB 2007-2009 databases. The outcomes of deep vein thrombosis (DVT) and pulmonary embolism (PE) were examined in relation to demographic variables, comorbidities, injury characteristics, and hospital course.  Multivariable logistic regression was performed to ascertain independent risk factors for the development of VTE.

Results 80.278 pediatric patients were identified from the NTDB of which 38.456 had complications recorded.  There were 292 DVT and 67 PE recorded, for rates of 76 per 10.000 and 17 per 10.000 respectively.  Patients ≤ 5 or ≥ 15 years old had significantly higher rates of DVT compared with those aged 6-14 (0.74% and 1.05% vs. 0.29%, p<0.0001).  The rate of pediatric DVT was also significantly higher in patients requiring mechanical ventilation (0.36% vs. 3.58%, p< 0.0001).  Obesity, head injury, vital signs at the time of admission, presence of chest injury and Glasgow Coma Scale score were not associated with the development of VTE.  Multivariable logistic regression did identify age, bleeding disorder, ventilator days, lower extremity or pelvic fracture, and spinal cord injury as independent risk factors for DVT with an AROC of 0.83.

Conclusion

While VTE remains rare in pediatric trauma patients, it is increasingly recognized and diagnosed according to multiple studies.  In the present study, the rate of VTE among trauma patients age 18 and younger as measured by the NTDB was 93 per 10.000,which is higher than previously reported rates. Multiple risk factors for VTE were identified by multivariable logistic regression, including age less than 6 years or greater than 14 years, duration of mechanical ventilation, lower extremity or pelvic fracture, and spinal cord injury. The most significant risk factor identified was the need for mechanical ventilation, with VTE rates increasing with longer duration of ventilation. While routine venous thromboembolic prophylaxis is not warranted based on the rarity of the event, consideration should be given to prophylaxis in patients with identified risk factors.