Risk factors for venous thromboembolism after pediatric trauma ★

Background/purposeThe purposes of this study were to identify independent predictors of venous thromboembolism (VTE), to evaluate the relative impact of adult VTE risk factors, and to identify a pediatric population at high-risk for VTE after trauma.Methods1934 consecutive pediatric admissions (≤ 17 years) from 01/2000 to 12/2012 at a level 1 trauma center were reviewed. Logistic regression was used to identify predictors of VTE.ResultsTwenty-two patients (1.2%) developed a VTE, including 5% of those requiring orthopedic surgery, 14% of those with major vascular injury (MVI), and 36% of those with both. Most (84%) were diagnosed at the primary site of injury. 86% of those who developed a VTE were receiving thromboprophylaxis at the time of diagnosis. Independent predictors were age (odds ratio (OR): 1.59, 95% confidence interval (CI): 1.11–2.25), orthopedic surgery (OR: 8.10, CI: 3.10–21.39), transfusion (OR: 3.37, CI: 1.26–8.99), and MVI (OR: 15.43, CI: 5.70–41.76). When known risk factors for VTE in adults were adjusted, significant factors were age ≥ 13 years (OR: 9.16, CI: 1.08–77.89), indwelling central venous catheter (OR: 4.41, CI: 1.31–14.82), orthopedic surgery (OR: 6.80, CI: 2.47–18.74), and MVI (OR: 14.41, CI: 4.60–45.13).ConclusionMVI and orthopedic surgery are synergistic predictors of pediatric VTE. Most children who developed a VTE were receiving thromboprophylaxis at the time of diagnosis.