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Incidence of venous thromboembolism in hospitalized pediatric neurosurgical patients: a retrospective 25-year institutional experience

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Abstract

Purpose

Venous thromboembolism (VTE) refers to both deep venous thrombosis (DVT) and pulmonary embolism (PE). The risk of VTE in adult neurosurgical patients is thoroughly studied. However, the incidence and risk of VTE in a comprehensive pediatric neurosurgical population is not well-defined. The available pediatric data consists of reviews of specific high-risk groups, such as trauma, critical care, or cancer patients. This may not be reflective of the entire spectrum of a high-volume pediatric neurosurgery practice. This study was undertaken to analyze the incidence and risk factors of VTE in all hospitalizations evaluated by a pediatric neurosurgery service over a 25-year period.

Methods

A retrospective review of electronic medical records was performed for 9149 hospitalizations in 6374 unique patients evaluated by the pediatric neurosurgery service at Riley Hospital for Children (Indianapolis, IN, USA) from 1990–2014. During this time period, there was no standardized VTE prevention protocol. The study group included all patients less than 18 years of age. Patients with a known pre-existing VTE or pregnancy were excluded.

Results

VTE was diagnosed in 20 of the 9149 (0.22%) hospitalizations, in 18 unique patients. All DVTs were diagnosed via Doppler ultrasound and/or computed tomography. Anatomic clot locations included 9 in the upper extremity (0.098% of hospitalizations), 8 in the lower extremity (0.087%), and 4 (0.044%) pulmonary emboli. Ten of the 20 occurred in hospitalizations where the patient underwent surgery, although the need for surgery was not a statistically significant risk factor. Sixteen of the 20 (80%) occurred in patients with at least one form of central venous line (p < 0.00001). There was one VTE-related death (0.01%).

Conclusions

In all pediatric neurosurgical patients, a VTE was found in 0.22% of hospitalizations over a 25-year span. Statistically significant risk factors for VTE included central venous line placement, paralysis, malignancy, intubation greater than 48 h, and hypercoagulable state.

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Abbreviations

VTE:

Venous thromboembolism

PE:

Pulmonary edema

DVT:

Deep vein thrombosis

LMWH:

Low molecular weight heparin

PICC:

Peripherally inserted central catheter

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Acknowledgments

We would like to thank the following people for data collection and organization: Kenneth Moore, MD; Benjamin K. Hendricks, MD; Katarzyna Kania, MD; Michael Tu, MD; Kareem Albaba, MD; Christian P. Gage, MD; Andrew Pavlina, MD; Zachary J. Plummer, MD; and Jacqueline M. Rees, MD.

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Authors and Affiliations

  1. Department of Radiology, Aurora St. Luke’s Medical Center, Milwaukee, WI, USA

    Mason A. Brown

  2. Beacon Children’s Hospital, Beacon Medical Group North Central Neurosurgery, Indiana University School of Medicine, 100 W. Navarre St., Suite #6600, South Bend, IN, 46601, USA

    Daniel H. Fulkerson

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Correspondence to Daniel H. Fulkerson.

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This study was conducted following Institutional Review Board approval and in accordance with university policy.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Brown, M.A., Fulkerson, D.H. Incidence of venous thromboembolism in hospitalized pediatric neurosurgical patients: a retrospective 25-year institutional experience. Childs Nerv Syst 36, 987–992 (2020). https://doi.org/10.1007/s00381-019-04389-5

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