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Risk Factors for Venous Thromboembolism in Pediatric Trauma

Vavilala, Monica S. MD; Nathens, Avery B. MD, PhD, MPH; Jurkovich, Gregory J. MD; Mackenzie, Ellen PhD; Rivara, Frederick P. MD, MPH

The Journal of Trauma: Injury, Infection, and Critical Care: May 2002 - Volume 52 - Issue 5 - p 922-927
Original Articles
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Background  Venous thromboembolism (VTE) is a major source of morbidity in critically ill trauma patients. Although the incidence and risk factors for VTE after trauma in adults have been well described, similar data regarding pediatric patients are lacking.

Methods  Pediatric (age < 16 years) trauma patients with VTE were identified from a large administrative database collated from 19 states across the United States. Risk factors for VTE were identified using multivariate techniques.

Results  Risk of VTE increased with age and Injury Severity Scores. VTE was clearly associated with head, thoracic, abdominal, lower extremity, and spinal injuries. Craniotomy, laparotomy, and spinal operations were also associated with VTE. The greatest risk of VTE was in children with venous catheters.

Conclusion  Older children with high Injury Severity Scores, major vascular injury, craniotomy, or venous catheters are at risk for VTE. These data may help guide strategies geared toward screening and prophylaxis in injured children.

From the Departments of Anesthesiology (M.S.V.), Surgery (A.B.N., G.J.J.), and Pediatrics (M.S.V., F.P.R.), University of Washington, Harborview Injury Prevention and Research Center (A.B.N., G.J.J., F.P.R.), Seattle, Washington, Injury Research and Policy Center (E.M.), Johns Hopkins University, Baltimore, Maryland, and the National Study on Costs and Outcomes of Trauma Care (A.B.N., G.J.J., E.M., F.P.R.).

Submitted for publication November 6, 2001.

Accepted for publication January 9, 2002.

Supported by grant R49/CCR316840 from the Centers for Disease Control and Prevention.

Address for reprints: Monica S. Vavilala, MD, Department of Anesthesiology, Harborview Medical Center, Box 359724, 325 9th Avenue, Seattle, WA 98104; email: vavilala@u.washington.edu.

© 2002 Lippincott Williams & Wilkins, Inc.