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In the absence of a central venous catheter, risk of venous thromboembolism is low in critically injured children, adolescents, and young adults: Evidence from the National Trauma Data Bank*

O'Brien, Sarah H. MD; Candrilli, Sean D. PhD

Pediatric Critical Care Medicine: May 2011 - Volume 12 - Issue 3 - p 251-256
doi: 10.1097/PCC.0b013e3181f36bd9
Feature Articles

Objective: To describe the incidence and risk factors of venous thromboembolism in a large sample of critical care pediatric, adolescent, and young adult trauma patients.

Data Source: The National Trauma Data Bank—the largest and most complete aggregation of trauma registry data in the United States.

Setting: Seven hundred eighty-four level I to level IV trauma centers.

Patients: Patients ≤21 yrs of age who spent at least 1 day in a critical care unit during a trauma admission between 2001 and 2005.

Measurements and Main Results: To characterize differences between patients with and without venous thromboembolism, we extracted variables regarding patient demographics, injury pattern and severity, procedures, total length of stay, and intensive care unit and ventilator days. Odds ratios for predictors of venous thromboembolism were estimated with a logistic regression model. Among the 135,032 critical care patients analyzed, venous thromboembolism was uncommon (6 per 1,000 discharges). Placement of a central venous catheter was a significant predictor of venous thromboembolism (odds ratio = 2.24; p < .0001) when populations were analyzed collectively. When we narrowed our focus to injuries associated with venous thromboembolism, such as lower-extremity fractures, the effects of central venous catheter were of even greater magnitude, particularly in adolescents and young adults. The risk of venous thromboembolism in critical care patients without a central venous catheter was <1% even in adolescents/young adults.

Conclusions: Venous thromboembolism is rare in young critical care trauma patients, even older adolescents. The absence of published data on both the baseline risk of venous thromboembolism in pediatric critical care patients and the efficacy and safety of venous thromboembolism prophylaxis preclude the ability to make definitive recommendations for the use of venous thromboembolism prophylaxis in this setting. Our results, however, suggest that venous thromboembolism prophylaxis may need to be considered only in critically injured adolescents and young adults with a continuing need for central venous access.

From the Center for Innovation in Pediatric Practice (SHO), The Research Institute at Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Hematology/Oncology (SHO), Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH; Division of Pharmacy Practice and Administration (SDC), College of Pharmacy, The Ohio State University, Columbus, OH; RTI Health Solutions (SDC), Research Triangle Park, NC.

Supported, in part, by the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville, MD (grant R03HS017344).

The authors have not disclosed any potential conflicts of interest. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

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©2011The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies