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Pediatric trauma venous thromboembolism prediction algorithm outperforms current anticoagulation prophylaxis guidelines: a pilot study

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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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Abbreviations

VTE:

Venous thromboembolism

DVT:

Deep vein thrombosis

PE:

Pulmonary embolism

ISS:

Injury Severity Score

GCS:

Glasgow Coma Score

ICU:

Intensive care unit

CVL:

Central venous line

NTDB:

National Trauma Data Bank

ICD-9/10:

International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification

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Funding

This research did not receive any specific funding or grant support from agencies in the public, commercial, or not-for-profit sectors.

Author information

All authors attest that they meet the current ICMJE criteria for Authorship. Specific contributions are listed here: study conception and design: AC, ED, CC, MS, MJ. Data acquisition: AC, LM, KD, MS, MJ. Analysis and data interpretation: AC, ED, SL, KH, EB, SK, NH, MS, MJ. Drafting of the manuscript: AC, ED, SL, NH, SK, MJ. Critical revision: AC, ED, SL, KH, EB, CC, LM, KD, NH, SK, MS, MJ.

Correspondence to Aaron J. Cunningham.

Ethics declarations

Conflict of interest

The following authors AC, ED, SL, KH, EB, CC, LM, KD, NH, SK, MS, MJ have no financial disclosures.

Patient consent

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

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Keywords

  • Venous thromboembolism
  • Pediatric trauma
  • Thromboprophylaxis
  • Guidelines