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The Importance of a Standardized Screening Tool to Identify Thromboembolic Risk Factors in Pediatric Lower Extremity Arthroscopy Patients

Ellis, Henry Bone Jr, MD; Sabatino, Meagan J., BA; Clarke, Zachary, BS; Dennis, Garrett, BS; Fletcher, Amanda L., CPNP; Wyatt, Charles W., CPNP; Zia, Ayesha, MD; Wilson, Philip L., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: May 1, 2019 - Volume 27 - Issue 9 - p 335–343
doi: 10.5435/JAAOS-D-18-00390
Research Article

Introduction: Deep vein thrombosis and pulmonary embolism are major complications that can occur in common orthopaedic procedures such as knee arthroscopy. The purpose of this study is to determine the incidence of venous thromboembolism (VTE) risk factors in adolescent patients undergoing elective lower extremity arthroscopy. A second objective is to determine whether a targeted, standardized screening tool is both cost- and clinically effective in the identification of VTE risk factors in adolescents.

Methods: A standardized VTE screening tool was prospectively administered to all elective arthroscopic procedures in a pediatric sports medicine practice. A comparison cohort that did not complete the screening tool was isolated through a retrospective chart review identifying VTE risk factors. The incidence and cost between the two cohorts were compared.

Results: Of 332 subjects who did not receive a targeted screening (TS) tool, 103 risk factors were noted. One pulmonary embolism case was identified with a total incidence of 0.15% over 3 years. With TS, we identified 325 subjects with 134 identifiable risk factors. Six patients (1.8%) were noted to be very high risk, requiring consultation with hematology. No VTEs were reported. When compared with the retrospective review, TS identified 30% more risk factors. A significant increase in the identification of family history of blood clots (P < 0.001), history of previous blood clot (P = 0.059), recurrent miscarriages in the family (P = 0.010), and smoking exposure (P = 0.062) was found. Additionally, the total cost of screening was less than the cost of prophylaxis treatment with no screening ($20.98 versus $23.51 per person, respectively).

Discussion: Risk factors for VTE may be present in 32.5% of elective adolescent arthroscopic patients. A TS model for VTE identified 30% more risk factors, especially a significant family history, and was shown to be a cost-effective way to safely implement a VTE prevention program.

Level of Evidence: Level II

From the Department of Orthopaedics (Dr. Ellis, Ms. Sabatino, Mr. Clarke, Mr. Dennis, Ms. Fletcher, Mr. Wyatt, and Dr. Wilson), Texas Scottish Rite Hospital for Children, and the Department of Orthopaedic Surgery (Dr. Ellis, and Dr. Wilson), and Department of Pediatrics-Hematology-Oncology (Dr. Zia), University of Texas Southwestern, Dallas, TX.

Correspondence to Dr. Ellis: henry.ellis@tsrh.org

Dr. Ellis or an immediate family member serves as a paid consultant to Smith & Nephew; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from Allosource, Ossur, and Varicel; and serves as a board member, owner, officer, or committee member of Pediatric Orthopaedic Society of North America and Pediatric Research in Sports Medicine. Dr. Wilson or an immediate family member has received research or institutional support from Allosource and Ossur and serves as a board member, owner, officer, or committee member of American Academy of Orthopaedic Surgeons and Pediatric Orthopaedic Society of North America. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Ms. Sabatino, Mr. Clarke, Mr. Dennis, Ms. Fletcher, Mr. Wyatt, and Dr. Zia.

© 2019 by American Academy of Orthopaedic Surgeons
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