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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

Pediatric Critical Care Medicine: July 2012 - Volume 13 - Issue 4 - p 381–386
doi: 10.1097/PCC.0b013e31823893f5
Feature Articles

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.

From the Departments of Pharmacy (PDR), Nursing (BW), Pediatrics (ELD), and Clinical Pharmacy (RV), School of Pharmacy, Section of Pediatric Critical Care (ELD), University of Colorado at Denver, Denver, CO; and The Children’s Hospital (RV), Aurora, CO.

*See also p. 481.

The authors have not disclosed any potential conflicts of interest.

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