USF-LVHN SELECT
Development of a new risk score for hospital-associated venous thromboembolism in critically-ill children not undergoing cardiothoracic surgery.
Publication/Presentation Date
10-1-2015
Abstract
BACKGROUND: Although risk of hospital-associated venous thromboembolism (HA-VTE) differs between critically and non-critically ill children, studies to date have not led to distinct, pragmatic risk scores.
OBJECTIVE: To determine risk factors for HA-VTE in critically ill children not undergoing cardiothoracic surgery, in order to derive a novel HA-VTE risk score for this population.
METHODS: We conducted a retrospective analysis from January 2006 through April 2013 at All Children's Hospital Johns Hopkins Medicine. HA-VTE cases were identified using ICD-9 discharge diagnosis codes, with subsequent validation via radiologic record review. Cases were restricted to Pediatric Intensive Care Unit (PICU) admissions. Patients who underwent cardiothoracic surgery were excluded; cardiac catheterization per se was not exclusionary. For each case, three non-HA-VTE PICU controls were randomly selected. Data were abstracted on putative risk factors, and associations between risk factors and HA-VTE were estimated using odds ratios (ORs) and 95% confidence intervals (95%CIs).
RESULTS: There were 57 HA-VTE cases and 171 controls. HA-VTE occurrence was 3 per 1000 PICU admissions (0.3%). Central venous catheter (CVC) (OR:26.64; 95%CI:7.46-95.13), length of stay (LOS) ≥4days (OR:20.22; 95%CI:2.27-180.07), and significant infection (OR:3.41; 95%CI:1.13-10.29) were independent, statistically-significant risk factors for HA-VTE in a multivariate model. A risk score was derived in which HA-VTE risk exceeded 2% (threshold for anticoagulant thromboprophylaxis in hospitalized adults) with a score of 15, and was >1% but
CONCLUSION: The presence of a CVC, LOS≥4days and infection are significant risk factors for HA-VTE in critically ill children not undergoing cardiothoracic surgery, forming the basis for a new risk score that warrants prospective validation.
Volume
136
Issue
4
First Page
717
Last Page
722
ISSN
1879-2472
Published In/Presented At
Arlikar, S. J., Atchison, C. M., Amankwah, E. K., Ayala, I. A., Barrett, L. A., Branchford, B. R., Streiff, M. B., Takemoto, C. M., & Goldenberg, N. A. (2015). Development of a new risk score for hospital-associated venous thromboembolism in critically-ill children not undergoing cardiothoracic surgery. Thrombosis research, 136(4), 717–722. https://doi.org/10.1016/j.thromres.2015.04.036
Disciplines
Medical Education | Medicine and Health Sciences
PubMedID
25979250
Department(s)
USF-LVHN SELECT Program, USF-LVHN SELECT Program Students
Document Type
Article