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Venous Thromboembolism in Children: Details of 46 Cases Based on a Follow-up Survey of POSNA Members

Sabharwal, Sanjeev MD, MPH; Zhao, Caixia MD; Passanante, Marian PhD

doi: 10.1097/BPO.0b013e31829d55e3
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Introduction: On the basis of a recent survey of Pediatric Orthopedic Society of North America members, 59% of the respondents acknowledged having encountered at least 1 child with the diagnosis of venous thromboembolism (VTE). The current survey sought further information including patient demographics, underlying diagnosis, presence of certain risk factors for VTE, and the clinical outcome.

Methods: A follow-up web-based questionnaire was sent to 121 active members of Pediatric Orthopedic Society of North America who had provided their contact information in the prior survey. Thirty-eight respondents provided clinical details on 46 children.

Results: The mean age of the affected patients was 14.3 (95% confidence interval, 13.3-15.3) years and 61% were males. The average body mass index was 28 (95% confidence interval, 25-31). Forty-four percent of the patients were diagnosed with deep venous thrombosis (DVT) only, 26% with pulmonary embolism (PE) only, and 30% with both DVT and PE. Majority of the children had DVT involving the popliteal area or thigh (16 cases each). Lower extremity surgery (29 cases, including proximal femoral/tibial osteotomies, internal fixation of long bone fractures, anterior cruciate ligament reconstruction, and resection of osteochondroma around the knee) and adolescence (28 cases) were the 2 most commonly cited associations. Other cases were noted with spinal surgery (8 children) and musculoskeletal infections (7 children). Three patients developed a postphlebitic syndrome, 1 had recurrent DVT and 2 children died. Both deceased children were diagnosed with DVT and PE including a 9-year-old child with a positive family history of antithrombin-3 deficiency that was not noted preoperatively.

Conclusions: Although uncommon, potentially fatal VTE can occur among children with a variety of musculoskeletal ailments. Obtaining a family history suggestive of thrombophilia preoperatively should be encouraged. Further investigation is warranted to ascertain the role of prophylaxis against VTE among children in an orthopaedic practice.

Level of Evidence: Level IV—case series.

Department of Orthopedics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ

None of the authors received financial support for this study.

The authors declare no conflict of interest.

Reprints: Sanjeev Sabharwal, MD, MPH, Department of Orthopedics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, 90 Bergen Street, Doctor’s Office Center, Suite 7300, Newark, NJ 07103. E-mail:

© 2013 by Lippincott Williams & Wilkins