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Efficacy of surveillance ultrasound for venous thromboembolism diagnosis in critically ill children after trauma. J Pediatr Surg 2018 Nov;53(11):2195-2201

Date

07/13/2018

Pubmed ID

29997028

DOI

10.1016/j.jpedsurg.2018.06.013

Scopus ID

2-s2.0-85049479648   3 Citations

Abstract

INTRODUCTION: Venous thromboembolism (VTE) is increasingly prevalent in injured children admitted to the intensive care unit (ICU). Few data exist to support VTE pharmacologic prophylaxis or ultrasound (US) surveillance in children with high bleeding risk. After implementation of screening US guidelines, we sought to describe our experience, hypothesizing that screening US of children at highest risk for VTE results in earlier detection and management.

STUDY DESIGN: A retrospective analysis was conducted on prospectively collected data of injured children admitted to an American College of Surgeons Verified level 1 Pediatric Trauma Center from 2010 to 2015. In patients at high risk for both VTE and bleeding (HRHR), guidelines recommended deferral of pharmacologic prophylaxis and a screening US at ≥7 ICU days if bleeding risk remained. Outcomes analyzed included VTE rates, guideline compliance, and US timing. The rate of deep vein thrombosis (DVT) detection (number of DVT captured/number of US obtained) was examined.

RESULTS: Of 4061 trauma patients, 588 (14.5%) were critically injured including 112 patients who met HRHR criteria. The rate of VTE in the HRHR group ≥7 ICU days was 25% (14/56). Of 23 VTE diagnosed in the ICU, 17 were detected by 49 US performed (34.7%), with the remaining 6 diagnosed by computed tomography. DVT was detected earlier than the US guideline recommended 7 days, independent of symptoms. Guideline compliance was 86%.

CONCLUSION: Critically injured children at risk for bleeding frequently develop VTE. Surveillance ultrasound in patients at high risk for both VTE and bleeding allows earlier detection and treatment.

LEVEL OF EVIDENCE: Therapeutic study, level II.

Author List

Landisch RM, Hanson SJ, Punzalan RC, Braun K, Cassidy LD, Gourlay DM

Authors

Laura Cassidy PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
David M. Gourlay MD Chief, Professor in the Surgery department at Medical College of Wisconsin
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

Child
Critical Illness
Humans
Retrospective Studies
Ultrasonography
Venous Thromboembolism
Wounds and Injuries
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a