Effectiveness of clinical guidelines for deep vein thrombosis prophylaxis in reducing the incidence of venous thromboembolism in critically ill children after trauma. J Trauma Acute Care Surg 2012 May;72(5):1292-7
Date
06/08/2012Pubmed ID
22673257DOI
10.1097/TA.0b013e31824964d1Scopus ID
2-s2.0-84864550787 (requires institutional sign-in at Scopus site) 78 CitationsAbstract
BACKGROUND: Historically, 6% of critically ill children developed clinically apparent venous thromboembolism (VTE) after trauma at our Level I pediatric trauma center. We hypothesized that implementation of clinical guidelines for thrombosis prophylaxis incorporating both VTE risk and bleeding risk would reduce VTE incidence without increased bleeding.
METHODS: VTE, both clinically apparent and those only detected by guideline-directed screening, were prospectively identified for all children admitted to the intensive care unit after trauma during three time periods: preimplementation of guidelines for VTE thromboprophylaxis (PRE; April 1, 2006-June 30, 2007), the intervening period (ROLL OUT; July 1, 2007-November 4, 2008), and postguideline implementation (POST; November 5, 2008-June 1, 2010). For patients classified as high risk for VTE, anticoagulation was recommended. For those patients at high risk of VTE with high risk of bleeding, anticoagulation was deferred and screening ultrasound performed.
RESULTS: Fourteen of 546 subjects developed VTE. There was a decrease in total VTE (p = 0.041) and clinical VTE (p = 0.001) after guideline implementation. The nine VTE PRE (5.2%) were clinically symptomatic, while the three VTE POST (1.8%) were detected by guideline-directed screening ultrasound. Implementation of guidelines did not increase overall thromboprophylaxis, with decreased anticoagulation in patients at low risk of VTE. No bleeding complications occurred. No patients classified by the guidelines as low risk for VTE developed VTE.
CONCLUSION: The incidence of clinical VTE and total VTE decreased after implementation of clinical guidelines for thromboprophylaxis in critically ill children after trauma. This decrease in VTE was not associated with increased prophylactic anticoagulation nor increased bleeding. The guidelines were predictive in identifying patients at low risk for VTE.
LEVEL OF EVIDENCE: II, therapeutic study.
Author List
Hanson SJ, Punzalan RC, Arca MJ, Simpson P, Christensen MA, Hanson SK, Yan K, Braun K, Havens PLAuthors
Rowena C. Punzalan MD Associate Professor in the Pediatrics department at Medical College of WisconsinPippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Ke Yan PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentChild
Child, Preschool
Critical Illness
Female
Follow-Up Studies
Guideline Adherence
Humans
Incidence
Infant
Infant, Newborn
Intensive Care Units, Pediatric
Male
Practice Guidelines as Topic
Prognosis
Prospective Studies
Risk Factors
Survival Rate
United States
Venous Thrombosis
Wounds and Injuries
Young Adult
