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Venous Thromboembolic Events in Pediatric Trauma Patients: Is Prophylaxis Necessary?

Azu, Michelle C. MD; McCormack, Jane E. RN; Scriven, Richard J. MD; Brebbia, John S. MD; Shapiro, Marc J. MD; Lee, Thomas K. MD

The Journal of Trauma: Injury, Infection, and Critical Care: December 2005 - Volume 59 - Issue 6 - p 1345-1349
doi: 10.1097/01.ta.0000196008.48461.47
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Background: Venous thromboembolic events (VTE), such as deep vein thrombosis and pulmonary embolism, are major morbidities in adult trauma patients. Invasive and noninvasive prophylactic therapies are used to prevent VTE in trauma patients. The risk of VTE in pediatric patients is not well known. Is VTE prophylaxis necessary in the pediatric trauma population?

Methods: This is a retrospective study from the trauma registry of a Level I trauma center from January 1, 1994, through December 31, 2003. Three separate age groups were reviewed: Group I, age less than 13 years; group II, age 13 to 17 years; and group III, age greater than 17 years. Group I did not receive any VTE prophylaxis. All patients in group III received invasive and noninvasive prophylaxis if not contraindicated. In group II, VTE prophylaxis was administered at the preference of the attending surgeon. All patients were assigned an Injury Severity Score at discharge.

Results: A total of 13,880 patients were identified. Groups I, II, and III had 1,192; 1,021; and 10,568 patients, respectively. In group I, no patient developed a VTE. Two patients in group II developed VTE. Both had an Injury Severity Score of >24 and both had contraindication to invasive prophylaxis. In group III, 59 patients developed VTE.

Conclusion: The risk of clinically significant thromboembolic event in trauma patients under age 13 is negligible. Therefore, VTE prophylaxis is unnecessary in pediatric patients with traumatic injury.

From the Department of Surgery, Stony Brook University Hospital, Stony Brook, New York.

Submitted for publication July 24, 2005.

Accepted for publication September 15, 2005.

Presented as a poster at the 18th annual scientific meeting of the Eastern Association for the Surgery of Trauma, January 11–15, 2005, Ft. Lauderdale, Florida.

Address for reprints: Thomas K. Lee, MD, Division of Pediatric Surgery, Department of Surgery, Health Sciences Center T-19, Stony Brook University, Stony Brook, NY 11974; email: tklee@notes.cc.sunysb.edu.

© 2005 Lippincott Williams & Wilkins, Inc.