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Screening Guidelines for Venous Thromboembolism Risk in Hospitalized Children Have Low Sensitivity for Central Venous Catheter-Associated Thrombosis. Hosp Pediatr 2017 01;7(1):39-45

Date

12/15/2016

Pubmed ID

27965360

DOI

10.1542/hpeds.2016-0078

Scopus ID

2-s2.0-85050580478   2 Citations

Abstract

OBJECTIVES: Local pediatric screening guidelines for venous thromboembolism (VTE) are developed from incomplete pediatric data and extrapolated from adult data in which immobility is a major risk factor. We hypothesized that screening guidelines centered on immobility are inadequate for identifying children at risk of central venous catheter (CVC)-associated VTE.

METHODS: This retrospective case-control (4:1) study at an academic, quaternary-level, free-standing children's hospital applied screening guidelines for VTE risk to all cases of VTE from July 2012 to April 2014. Cases and controls were classified as "at risk" or "not at risk" of VTE by guideline criteria. These guidelines assessed VTE risk factors, including CVC, as reported in the pediatric literature.

RESULTS: VTE prevalence was 0.5 per 100 admissions. Sixty-nine of 114 patients with radiographically confirmed VTE were classified as being "at risk" by the guidelines, with a sensitivity of 61%, specificity of 90.8%, a positive predictive value of 2.4%, and negative predictive value of 99.8%. There was no difference in screening guidelines sensitivity for identifying CVC-associated VTE versus non-CVC-associated VTE. Half of the 45 patients with VTE who were not captured as being "at risk" did not have decreased mobility, the entry point to the algorithm, and 80% of these patients had a CVC.

CONCLUSIONS: Screening guidelines have low sensitivity for identifying hospitalized children at increased risk of both CVC-associated and other VTE events. Decreased mobility is not a requirement for CVC-associated VTE. Risk factors extrapolated from adult data are insufficient for identifying children at risk of VTE.

Author List

Asfaw AB, Punzalan RC, Yan K, Hoffmann RG, Hanson SJ

Authors

Sheila Hanson 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




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

Adolescent
Case-Control Studies
Child
Child, Hospitalized
Female
Guidelines as Topic
Hospitalization
Humans
Male
Mass Screening
Predictive Value of Tests
Quality Improvement
Retrospective Studies
Risk Assessment
Risk Factors
Sensitivity and Specificity
United States
Upper Extremity Deep Vein Thrombosis
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a