C. M. Schneider1, M. Jackson1, M. Harting1, B. Cotton1, C. Cox1 1University Of Texas Health Science Center At Houston,Houston, TX, USA
Introduction: Venous thromboembolism (VTE) is a major source of morbidity and mortality among adult trauma patients, and pulmonary embolism (PE) was once the leading cause of preventable in-hospital adult deaths. These data drove the initiation of guidelines for VTE prophylaxis. Comparatively, the incidence of VTE among pediatric trauma patients is lower than that of their adult counterparts despite aggressive implementation of VTE prophylaxis in adults. The aim of this study is to evaluate the risk factors and outcomes of VTE after injury in children admitted to our level-1 pediatric trauma center.
Methods: All pediatric trauma patients (15 and younger) admitted to a Level-1 Pediatric Trauma Center from January 2005 to August 2016 were screened for VTE. VTE events were defined as the documentation of deep venous thrombosis (DVT) detected by duplex ultrasonography and/or PE detected by helical computed tomography angiography (CTA) of the chest during the hospital stay or readmission. We evaluated the incidence, risk factors, and adverse events of VTE.
Results: A total of 14,018 pediatric trauma patients ≤ 15 years old were evaluated between 2005-2016, of which 1,842 patients were admitted as level-1 trauma team activations. Of those patients admitted, only 19 patients experienced VTE: 17 patients with DVT alone, 1 patient with PE alone, and 1 patient with both a DVT and PE. All 17 patients with DVT-alone were related to a central venous catheter (CVC) or a peripherally inserted central catheter (PICC). The two patients who experienced PE were 15 years old and both presented > 1 week after hospital discharge. One patient had a history of bilateral long-bone fracture repair, and the other was suspected to have embolized from a previous IV site.
Conclusion: Multiple previous studies have shown VTE rates among pediatric trauma patients to be lower than adult trauma patients. Unlike adult trauma patients, whose DVT burden is primarily in the calves or pelvic veins, pediatric trauma patients nearly universally develop DVT at catheter-related sites. The only PE identified were in older children (15 years old) whose risk of VTE transitions toward adult risk, as shown in previous studies. These data suggest that VTE prophylaxis of pediatric trauma patients without a CVC is unwarranted.
