Venous thromboembolism (VTE) in injured children is rare, but sequelae can be morbid and life-threatening. Recent trauma society guidelines suggesting that all children over 15 years old should receive thromboprophylaxis may result in overtreatment. We sought to evaluate the efficacy of a previously published VTE prediction algorithm and compare it to current recommendations.
Two institutional trauma registries were queried for all pediatric (age < 18 years) patients admitted from 2007 to 2018. Clinical data were applied to the algorithm and the area under the receiver operating characteristic (AUROC) curve was calculated to test algorithm efficacy.
A retrospective review identified 8271 patients with 30 episodes of VTE (0.36%). The VTE prediction algorithm classified 51 (0.6%) as high risk (> 5% risk), 322 (3.9%) as moderate risk (1–5% risk) and 7898 (95.5%) as low risk (< 1% risk). AUROC was 0.93 (95% CI 0.89–0.97). In our population, prophylaxis of the ‘moderate-’ and ‘high-risk’ cohorts would outperform the sensitivity (60% vs. 53%) and specificity (96% vs. 77%) of current guidelines while anticoagulating substantially fewer patients (373 vs. 1935, p < 0.001).
A VTE prediction algorithm using clinical variables can identify injured children at risk for venous thromboembolic disease with more discrimination than current guidelines. Prospective studies are needed to investigate the validity of this model.
Level of evidence
III—Clinical decision rule evaluated in a single population.
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Deep vein thrombosis
Injury Severity Score
Glasgow Coma Score
Intensive care unit
Central venous line
National Trauma Data Bank
International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification
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This research did not receive any specific funding or grant support from agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest
The following authors AC, ED, SL, KH, EB, CC, LM, KD, NH, SK, MS, MJ have no financial disclosures.
This study was exempted from obtaining individual patient consent as approved by our Institutional Review Board. This report does not contain any personal information that could lead to identification of any patients. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Cunningham, A.J., Dewey, E., Lin, S. et al. Pediatric trauma venous thromboembolism prediction algorithm outperforms current anticoagulation prophylaxis guidelines: a pilot study. Pediatr Surg Int 36, 373–381 (2020). https://doi.org/10.1007/s00383-019-04613-y
- Venous thromboembolism
- Pediatric trauma