Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: An increasing population at risk
Objective The optimal prophylactic strategy and treatment regimen for deep venous thrombosis (DVT) in hospitalized pediatric patients is not clearly established. This study assessed the incidence, risk factors, and treatment patterns for DVT among pediatric patients admitted to a hospital ward. Meth...
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| Veröffentlicht in: | Journal of vascular surgery 2008-04, Vol.47 (4), p.837-843 |
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| container_title | Journal of vascular surgery |
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| creator | Sandoval, John A., MD Sheehan, Michael P., MD Stonerock, Charles E., MD Shafique, Shoaib, MD Rescorla, Frederick J., MD Dalsing, Michael C., MD |
| description | Objective The optimal prophylactic strategy and treatment regimen for deep venous thrombosis (DVT) in hospitalized pediatric patients is not clearly established. This study assessed the incidence, risk factors, and treatment patterns for DVT among pediatric patients admitted to a hospital ward. Methods Children (aged |
| doi_str_mv | 10.1016/j.jvs.2007.11.054 |
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This study assessed the incidence, risk factors, and treatment patterns for DVT among pediatric patients admitted to a hospital ward. Methods Children (aged <17 years) admitted to a single tertiary-care hospital during a 14-year period who developed or presented with DVT were retrospectively identified. Patient demographic and clinical data were analyzed retrospectively. Patients who developed DVT in the hospital were stratified according to the Wells clinical probability scoring system from criteria noted before the diagnosis. Treatment patterns and outcomes were evaluated between the two time intervals of 1992 to 2001 (group I) and 2002 to 2005 (group II). Results Between 1992 and 2005, 358 children were evaluated for DVT, and 99 (52 boys, 47 girls) were admitted to the hospital and were determined to have DVT by confirmatory imaging. A prior DVT (12 total) was present in eight of the 21 patients admitted for DVT treatment; of the remaining, only seven received DVT prophylaxis on admission. In those developing a DVT, the inpatient clinical probability score was 21% (low), 40% (moderate), and 39% (high). The most common risk factor in those with prehospital DVT was a prior DVT (38%) or thrombophilic condition (33%), whereas inpatients had a central catheter (45%), with nearly 50% in the femoral vein. Children acquiring an inpatient DVT had concomitant severe respiratory (17%), oncologic (14%), and/or infectious (15%) diseases and required a prolonged intensive care unit (12.7 days) stay. Prehospital DVT was lower extremity predominant (90%) and statistically different from inpatient-acquired DVT (62%, P = .01). Treatment patterns between periods I and II revealed a trend to more low-molecular-weight heparin and less unfractionated heparin use ( P = .09). Three patients died (one fatal pulmonary embolism). The number of recognized cases per 10,000 admissions increased from 0.3 to 28.8 from 1992 to 2005. Conclusion The incidence of DVT in hospitalized children is increasing. Those presenting with DVT typically have prior DVT, thrombophilia, or lower extremity disease. Our study suggests that children admitted with severe medical conditions who require a prolonged intensive care unit stay in addition to central venous access (especially via the femoral vein) should be considered candidates for DVT prophylaxis. A clinical probability scoring system alone cannot stratify patients sufficiently to forgo prophylaxis in hopes of a rapid clinical diagnosis. Childhood-specific level 1 trials aimed at determining guidelines for DVT prophylaxis are urgently required.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2007.11.054</identifier><identifier>PMID: 18295440</identifier><identifier>CODEN: JVSUES</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adolescent ; Biological and medical sciences ; Child ; Child, Preschool ; Comorbidity ; Female ; Heparin, Low-Molecular-Weight - therapeutic use ; Hospitalization ; Humans ; Infant ; Male ; Medical sciences ; Orthopedic surgery ; Pulmonary Embolism - etiology ; Retrospective Studies ; Risk Factors ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Treatment Outcome ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels ; Venous Thrombosis - epidemiology ; Venous Thrombosis - etiology ; Venous Thrombosis - prevention & control ; Venous Thrombosis - therapy</subject><ispartof>Journal of vascular surgery, 2008-04, Vol.47 (4), p.837-843</ispartof><rights>The Society for Vascular Surgery</rights><rights>2008 The Society for Vascular Surgery</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c479t-1e53cb61f58fff32fdb7c6a6bed16c33d04c83cbc969adc5830dc88f2d0a11aa3</citedby><cites>FETCH-LOGICAL-c479t-1e53cb61f58fff32fdb7c6a6bed16c33d04c83cbc969adc5830dc88f2d0a11aa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521407019027$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20259195$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18295440$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sandoval, John A., MD</creatorcontrib><creatorcontrib>Sheehan, Michael P., MD</creatorcontrib><creatorcontrib>Stonerock, Charles E., MD</creatorcontrib><creatorcontrib>Shafique, Shoaib, MD</creatorcontrib><creatorcontrib>Rescorla, Frederick J., MD</creatorcontrib><creatorcontrib>Dalsing, Michael C., MD</creatorcontrib><title>Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: An increasing population at risk</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Objective The optimal prophylactic strategy and treatment regimen for deep venous thrombosis (DVT) in hospitalized pediatric patients is not clearly established. This study assessed the incidence, risk factors, and treatment patterns for DVT among pediatric patients admitted to a hospital ward. Methods Children (aged <17 years) admitted to a single tertiary-care hospital during a 14-year period who developed or presented with DVT were retrospectively identified. Patient demographic and clinical data were analyzed retrospectively. Patients who developed DVT in the hospital were stratified according to the Wells clinical probability scoring system from criteria noted before the diagnosis. Treatment patterns and outcomes were evaluated between the two time intervals of 1992 to 2001 (group I) and 2002 to 2005 (group II). Results Between 1992 and 2005, 358 children were evaluated for DVT, and 99 (52 boys, 47 girls) were admitted to the hospital and were determined to have DVT by confirmatory imaging. A prior DVT (12 total) was present in eight of the 21 patients admitted for DVT treatment; of the remaining, only seven received DVT prophylaxis on admission. In those developing a DVT, the inpatient clinical probability score was 21% (low), 40% (moderate), and 39% (high). The most common risk factor in those with prehospital DVT was a prior DVT (38%) or thrombophilic condition (33%), whereas inpatients had a central catheter (45%), with nearly 50% in the femoral vein. Children acquiring an inpatient DVT had concomitant severe respiratory (17%), oncologic (14%), and/or infectious (15%) diseases and required a prolonged intensive care unit (12.7 days) stay. Prehospital DVT was lower extremity predominant (90%) and statistically different from inpatient-acquired DVT (62%, P = .01). Treatment patterns between periods I and II revealed a trend to more low-molecular-weight heparin and less unfractionated heparin use ( P = .09). Three patients died (one fatal pulmonary embolism). The number of recognized cases per 10,000 admissions increased from 0.3 to 28.8 from 1992 to 2005. Conclusion The incidence of DVT in hospitalized children is increasing. Those presenting with DVT typically have prior DVT, thrombophilia, or lower extremity disease. Our study suggests that children admitted with severe medical conditions who require a prolonged intensive care unit stay in addition to central venous access (especially via the femoral vein) should be considered candidates for DVT prophylaxis. A clinical probability scoring system alone cannot stratify patients sufficiently to forgo prophylaxis in hopes of a rapid clinical diagnosis. Childhood-specific level 1 trials aimed at determining guidelines for DVT prophylaxis are urgently required.</description><subject>Adolescent</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Comorbidity</subject><subject>Female</subject><subject>Heparin, Low-Molecular-Weight - therapeutic use</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Infant</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Orthopedic surgery</subject><subject>Pulmonary Embolism - etiology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Treatment Outcome</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><subject>Venous Thrombosis - epidemiology</subject><subject>Venous Thrombosis - etiology</subject><subject>Venous Thrombosis - prevention & control</subject><subject>Venous Thrombosis - therapy</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kk2LFDEQhhtR3HH1B3iRXPS0Pab6K90uCMvix8KCB_UcMknFyWxP0qbSA-vd_23aGRQ8eMohT72VelJF8Rz4Gjh0r3fr3YHWFediDbDmbfOgWAEfRNn1fHhYrLhooGwraM6KJ0Q7zgHaXjwuzqCvhrZp-Kr4eeO1M-g1XrDo6I5ZpVOIdMGUNyxFVGmPPrFJpYTRE7MhMoM4sQP6MBNL2xj2m0COmPNsG2hySY3uBxqmt240Ef0bduXzpc5h5Pw3NoVpHlVywTOVfnd9WjyyaiR8djrPi6_v3325_ljefvpwc311W-pGDKkEbGu96cC2vbW2rqzZCN2pboMGOl3Xhje6z4QeukEZ3fY1N7rvbWW4AlCqPi9eHXOnGL7PSEnuHWkcR-UxDyMFb9pGiCaDcAR1DEQRrZyi26t4L4HLxb3cyexeLu4lgMzuc82LU_i82aP5W3GSnYGXJ0CRVqONKrunP1zFq3aAoc3c5ZHDrOLgMErSbvki4yLqJE1w_33G23-q9ei8yw3v8B5pF-bos2MJkirJ5edlSZYd4YLDwCtR_wJBxron</recordid><startdate>20080401</startdate><enddate>20080401</enddate><creator>Sandoval, John A., MD</creator><creator>Sheehan, Michael P., MD</creator><creator>Stonerock, Charles E., MD</creator><creator>Shafique, Shoaib, MD</creator><creator>Rescorla, Frederick J., MD</creator><creator>Dalsing, Michael C., MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20080401</creationdate><title>Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: An increasing population at risk</title><author>Sandoval, John A., MD ; Sheehan, Michael P., MD ; Stonerock, Charles E., MD ; Shafique, Shoaib, MD ; Rescorla, Frederick J., MD ; Dalsing, Michael C., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c479t-1e53cb61f58fff32fdb7c6a6bed16c33d04c83cbc969adc5830dc88f2d0a11aa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adolescent</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Comorbidity</topic><topic>Female</topic><topic>Heparin, Low-Molecular-Weight - therapeutic use</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Infant</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Orthopedic surgery</topic><topic>Pulmonary Embolism - etiology</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Treatment Outcome</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><topic>Venous Thrombosis - epidemiology</topic><topic>Venous Thrombosis - etiology</topic><topic>Venous Thrombosis - prevention & control</topic><topic>Venous Thrombosis - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sandoval, John A., MD</creatorcontrib><creatorcontrib>Sheehan, Michael P., MD</creatorcontrib><creatorcontrib>Stonerock, Charles E., MD</creatorcontrib><creatorcontrib>Shafique, Shoaib, MD</creatorcontrib><creatorcontrib>Rescorla, Frederick J., MD</creatorcontrib><creatorcontrib>Dalsing, Michael C., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sandoval, John A., MD</au><au>Sheehan, Michael P., MD</au><au>Stonerock, Charles E., MD</au><au>Shafique, Shoaib, MD</au><au>Rescorla, Frederick J., MD</au><au>Dalsing, Michael C., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: An increasing population at risk</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2008-04-01</date><risdate>2008</risdate><volume>47</volume><issue>4</issue><spage>837</spage><epage>843</epage><pages>837-843</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><coden>JVSUES</coden><abstract>Objective The optimal prophylactic strategy and treatment regimen for deep venous thrombosis (DVT) in hospitalized pediatric patients is not clearly established. This study assessed the incidence, risk factors, and treatment patterns for DVT among pediatric patients admitted to a hospital ward. Methods Children (aged <17 years) admitted to a single tertiary-care hospital during a 14-year period who developed or presented with DVT were retrospectively identified. Patient demographic and clinical data were analyzed retrospectively. Patients who developed DVT in the hospital were stratified according to the Wells clinical probability scoring system from criteria noted before the diagnosis. Treatment patterns and outcomes were evaluated between the two time intervals of 1992 to 2001 (group I) and 2002 to 2005 (group II). Results Between 1992 and 2005, 358 children were evaluated for DVT, and 99 (52 boys, 47 girls) were admitted to the hospital and were determined to have DVT by confirmatory imaging. A prior DVT (12 total) was present in eight of the 21 patients admitted for DVT treatment; of the remaining, only seven received DVT prophylaxis on admission. In those developing a DVT, the inpatient clinical probability score was 21% (low), 40% (moderate), and 39% (high). The most common risk factor in those with prehospital DVT was a prior DVT (38%) or thrombophilic condition (33%), whereas inpatients had a central catheter (45%), with nearly 50% in the femoral vein. Children acquiring an inpatient DVT had concomitant severe respiratory (17%), oncologic (14%), and/or infectious (15%) diseases and required a prolonged intensive care unit (12.7 days) stay. Prehospital DVT was lower extremity predominant (90%) and statistically different from inpatient-acquired DVT (62%, P = .01). Treatment patterns between periods I and II revealed a trend to more low-molecular-weight heparin and less unfractionated heparin use ( P = .09). Three patients died (one fatal pulmonary embolism). The number of recognized cases per 10,000 admissions increased from 0.3 to 28.8 from 1992 to 2005. Conclusion The incidence of DVT in hospitalized children is increasing. Those presenting with DVT typically have prior DVT, thrombophilia, or lower extremity disease. Our study suggests that children admitted with severe medical conditions who require a prolonged intensive care unit stay in addition to central venous access (especially via the femoral vein) should be considered candidates for DVT prophylaxis. A clinical probability scoring system alone cannot stratify patients sufficiently to forgo prophylaxis in hopes of a rapid clinical diagnosis. Childhood-specific level 1 trials aimed at determining guidelines for DVT prophylaxis are urgently required.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>18295440</pmid><doi>10.1016/j.jvs.2007.11.054</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Biological and medical sciences Child Child, Preschool Comorbidity Female Heparin, Low-Molecular-Weight - therapeutic use Hospitalization Humans Infant Male Medical sciences Orthopedic surgery Pulmonary Embolism - etiology Retrospective Studies Risk Factors Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels Venous Thrombosis - epidemiology Venous Thrombosis - etiology Venous Thrombosis - prevention & control Venous Thrombosis - therapy |
| title | Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: An increasing population at risk |
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