Venous Thrombotic Events in Hospitalized Children and Adolescents With Inflammatory Bowel Disease

Nylund, Cade M.*; Goudie, Anthony; Garza, Jose M.; Crouch, Gary*; Denson, Lee A.

Journal of Pediatric Gastroenterology & Nutrition: May 2013 - Volume 56 - Issue 5 - p 485–491
doi: 10.1097/MPG.0b013e3182801e43
Original Articles: Gastroenterology

Background: Adults with inflammatory bowel disease (IBD) have an increased risk of venous thrombotic events (TEs). We sought to evaluate the risk for TE in children and adolescents with IBD using a large population database.

Methods: The triennial Healthcare Cost and Utilization Project Kids’ Inpatient Database was used in a retrospective cohort study of hospitalized children in the United States across 1997, 2000, 2003, 2006, and 2009. Billing codes were used to identify discharges with Crohn disease, ulcerative colitis, pulmonary embolism, deep vein thrombosis, thrombophlebitis, thrombosis of intracranial venous sinus, Budd-Chiari syndrome, and portal vein thrombosis. A logistic regression model was fitted to quantify the increased risk of TE in children with IBD, while adjusting for other risk factors of thrombosis.

Results: The total weighted number of pediatric discharges was 7,448,292, and 68,394 (0.92%) were identified with IBD. The incidence of any TE in a hospitalized child or adolescent with IBD was 117.9/10,000 with a relative risk (95% confidence interval) of 2.36 (2.15–2.58). The adjusted odds ratio for any TE in a patient with IBD without surgery was 1.22 (1.08–1.36). Risk factors for TE among patients with IBD include older age, central venous catheter, parenteral nutrition, and an identified hypercoagulable condition. There is an increasing trend of TE in both the IBD and non-IBD patients.

Conclusions: Hospitalized children and adolescents with IBD are at increased risk for TE. Conservative methods of TE prevention including hydration, mobilization, or pneumatic devices should be considered in hospitalized patients with IBD.

*Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD

Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock

Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Address correspondence and reprint requests to Cade M. Nylund, MD, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 (e-mail: cade.nylund@usuhs.mil).

Received 18 June, 2012

Accepted 27 November, 2012

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The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Air Force, Department of Defense, or the US government.

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,