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Incidence and risk factors for venous thromboembolism in critically ill children after trauma. J Trauma 2010 Jan;68(1):52-6

Date

01/13/2010

Pubmed ID

20065757

DOI

10.1097/TA.0b013e3181a74652

Scopus ID

2-s2.0-75649096012   92 Citations

Abstract

BACKGROUND: Venous thromboembolism (VTE) causes major morbidity in adults after trauma, occurring in up to 50% of patients without prophylaxis. The incidence of VTE after trauma is lower in children. No study has measured the incidence of and risk factors for VTE in critically ill children after trauma.

METHODS: Nested case-control study of children, younger than 18 years, admitted to the pediatric intensive care unit at a level I trauma center. Three controls were selected for each identified VTE case.

RESULTS: Nine of 144 children admitted to the pediatric intensive care unit after trauma developed VTE (incidence 6.2%, 95% confidence interval [CI] 2.3-10.2), with a median age of 8.6 years (range, 2.3-17.9). VTE was diagnosed at a median of 9 days after admission, with 67% of VTE located at the site of previous or existing central venous line (CVL). Significant risk factors for thrombosis included parenteral nutrition (odds ratio [OR] 20, 95% CI 1.9-227), CVL (OR 19, 95% CI 2-178), deep sedation (OR 13, 95% CI 1.6-48), neuromuscular blockade (OR 10, 95% CI 1.4-70), inotropic support (OR 10, 95% CI 1.7-59), and recombinant factor VIIa administration (p = 0.012, OR not calculable). Logistic analysis found a 7.9-fold increase in the odds of developing VTE for each additional CVL (p = 0.005), a threefold increase with each additional risk factor present (p = 0.009), and a 1.3-fold increase for an increase in injury severity (p = 0.03). VTE was not associated with sepsis, spinal cord injury, fracture, or elevated D-dimer level.

CONCLUSIONS: VTE is not a rare event in critically ill children after trauma. Most patients developing thrombosis have multiple risk factors, including poor perfusion, immobility, and presence of a CVL.

Author List

Hanson SJ, Punzalan RC, Greenup RA, Liu H, Sato TT, Havens PL

Authors

Sheila Hanson MD Professor in the Pediatrics department at Medical College of Wisconsin
Peter L. Havens MD Professor in the Pediatrics department at Medical College of Wisconsin
Rowena C. Punzalan MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Thomas T. Sato MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Catheterization, Central Venous
Child
Child, Preschool
Critical Illness
Female
Humans
Infant
Injury Severity Score
Intensive Care Units, Pediatric
Male
Risk Factors
Venous Thromboembolism
Wounds and Injuries
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a