Faculty Collaboration Database

Screening ultrasound for deep vein thrombosis detection in high-risk pediatric trauma. Pediatr Surg Int 2025 Apr 24;41(1):124

Date

04/24/2025

Pubmed ID

40272548

DOI

10.1007/s00383-025-06027-5

Scopus ID

2-s2.0-105003491751 (requires institutional sign-in at Scopus site)

Abstract

PURPOSE: Venous thromboembolism (VTE) is a rare but significant complication among high-risk pediatric trauma patients. The NO CLOT study's primary aim was to evaluate the safety of chemical prophylaxis against VTE in high-risk pediatric trauma patients with a secondary aim of evaluating the use of screening venous duplex ultrasound (sUS) to identify deep vein thrombosis (DVT). We hypothesized that sUS would detect asymptomatic DVT at a high rate in high-risk patients.

METHODS: A prospective multi-institutional study was performed at eight level one pediatric trauma centers from 2019 to 2022. sUS was recommended 7 days after admission for all high-risk trauma patients. Univariate and multivariate analyses were performed.

RESULTS: Of 460 high-risk trauma patients, 64/341 (18.8%) remained admitted on day 7 and underwent sUS. Ten of 64 (15.6%) had a DVT identified on sUS (median of 6.5 [IQR 5.2, 7.0] days after trauma). In 277 patients still admitted on day 7 without sUS performed, 15 (5.4%) developed symptomatic DVT (median of 6.0 [IQR 3.0, 8.0] days after trauma. For the sUS cohort, 9/10 (90%) DVTs were associated with an indwelling central venous line (CVL) and occurred either without chemical prophylaxis use at all in 4/10 (40%) or when initiated more than 24-h post-trauma in 6/10 (60%).

CONCLUSIONS: In this high-risk cohort, most DVTs were identified in the first week following injury; however, the majority were asymptomatic. Use of sUS at 1-week post-injury increases DVT detection; however, the clinical consequences of asymptomatic detection of DVT remain unknown.

LEVEL OF EVIDENCE: III.

Author List

Witte AB, Van Arendonk K, Falcone RA Jr, Moody S, Hartman HA, Evans E, Thakkar R, Patterson KN, Minneci PC, Mak GZ, Slidell MB, Johnson M, Landman MP, Markel TA, Leys CM, Cherney Stafford L, Draper J, Foley DS, Downard C, Skaggs TM, Lal DR, Ehrlich PF, Gourlay D

Author

Dave Lal MD, MPH Chief, Professor in the Surgery department at Medical College of Wisconsin

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

Adolescent
Child
Child, Preschool
Female
Humans
Infant
Male
Prospective Studies
Risk Factors
Trauma Centers
Ultrasonography, Doppler, Duplex
Venous Thrombosis
Wounds and Injuries