Development of a new risk score for hospital-associated venous thromboembolism in critically-ill children not undergoing cardiothoracic surgery

Shilpa J. Arlikar, Christie M. Atchison, Ernest K. Amankwah, Irmel A. Ayala, Laurie A. Barrett, Brian R. Branchford, Michael B. Streiff, Clifford M. Takemoto, Neil A. Goldenberg

Research output: Contribution to journalArticle

Abstract

Background Although risk of hospital-associated venous thromboembolism (HA-VTE) differs between critically and non-critically ill children, studies to date have not led to distinct, pragmatic risk scores. Objective To determine risk factors for HA-VTE in critically ill children not undergoing cardiothoracic surgery, in order to derive a novel HA-VTE risk score for this population. Methods We conducted a retrospective analysis from January 2006 through April 2013 at All Children's Hospital Johns Hopkins Medicine. HA-VTE cases were identified using ICD-9 discharge diagnosis codes, with subsequent validation via radiologic record review. Cases were restricted to Pediatric Intensive Care Unit (PICU) admissions. Patients who underwent cardiothoracic surgery were excluded; cardiac catheterization per se was not exclusionary. For each case, three non-HA-VTE PICU controls were randomly selected. Data were abstracted on putative risk factors, and associations between risk factors and HA-VTE were estimated using odds ratios (ORs) and 95% confidence intervals (95%CIs). Results There were 57 HA-VTE cases and 171 controls. HA-VTE occurrence was 3 per 1000 PICU admissions (0.3%). Central venous catheter (CVC) (OR:26.64; 95%CI:7.46-95.13), length of stay (LOS) ≥ 4 days (OR:20.22; 95%CI:2.27-180.07), and significant infection (OR:3.41; 95%CI:1.13-10.29) were independent, statistically-significant risk factors for HA-VTE in a multivariate model. A risk score was derived in which HA-VTE risk exceeded 2% (threshold for anticoagulant thromboprophylaxis in hospitalized adults) with a score of 15, and was > 1% but < 2% (risk zone for mechanical thromboprophylaxis in hospitalized adults) with scores of 7-14. Conclusion The presence of a CVC, LOS ≥ 4 days and infection are significant risk factors for HA-VTE in critically ill children not undergoing cardiothoracic surgery, forming the basis for a new risk score that warrants prospective validation.

Original languageEnglish (US)
Pages (from-to)717-722
Number of pages6
JournalThrombosis research
Volume136
Issue number4
DOIs
StatePublished - Oct 1 2015

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Keywords

  • Children
  • Critical care
  • Prevention
  • Risk factor
  • Risk score
  • Venous thromboembolism

ASJC Scopus subject areas

  • Hematology

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