Skip Navigation LinksHome > July 2012 - Volume 13 - Issue 4 > Thrombosis risk factor assessment and implications for preve...
Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e31823893f5
Feature Articles

Thrombosis risk factor assessment and implications for prevention in critically ill children*

Reiter, Pamela D. PharmD; Wathen, Beth MSN, RN; Valuck, Robert J. PhD; Dobyns, Emily L. MD

Collapse Box

Abstract

Objectives: To describe nursing compliance with a computer-based pediatric thrombosis risk assessment tool; to generate an estimate of risk factors present in our population; and to explore relationships between risk factors and confirmed thrombotic events.

Design: Institutional review board-approved prospective, observational cohort study.

Setting: Pediatric intensive care unit within a tertiary care children’s hospital.

Patients: All infants and children admitted to the pediatric intensive care unit during a 6-month study period (January 1, 2010–June 30, 2010).

Measurements and Main Results: Eight hundred admissions were enrolled, representing 742 patients. Thrombosis risk assessment scores were recorded for 707 admissions (88% of total). Mean age = 6.95 ± 6 yrs, mean weight = 28 ± 23 kg, 45% female. A total of 32 thrombi (14 prehospital and 18 in-hospital) were present in the study group. This translated to an overall occurrence rate of 4.3% (1.9% for prehospital and 2.4% for in-hospital). Logistic regression identified that for every 1-point increase in total thrombosis score, the risk of developing a symptomatic thrombus increased by 1.57-fold (95% confidence interval 0.192–5.5) to 2.12-fold (95% confidence interval 0.175–18.34), for prehospital and in-hospital thrombi, respectively (p < .05). The most important risk factors identified for development of any thrombus were thrombophilia (acquired or inherited) (p < .001), presence of a central catheter (p = .01), and age <1 or >14 yrs (p = .052).

Conclusions: Incorporation of a scoring system into the bedside nursing assessment flow sheet was successful and identified children at risk for in-hospital thrombosis. The overall score appears to be most indicative of thrombus risk. These data may serve as a platform for future development of routine screening and possible interventional trials in critically ill children.

©2012The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Login

Article Tools

Share

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.