TY - JOUR
T1 - Hospital-associated venous thromboembolism in children
T2 - Incidence and clinical characteristics
AU - Takemoto, Clifford M.
AU - Sohi, Sajeet
AU - Desai, Kruti
AU - Bharaj, Raman
AU - Khanna, Anuj
AU - McFarland, Susan
AU - Klaus, Sybil
AU - Irshad, Alia
AU - Goldenberg, Neil A.
AU - Strouse, John J.
AU - Streiff, Michael B.
PY - 2014/2
Y1 - 2014/2
N2 - Objective To determine incidence and clinical characteristics of hospital-associated venous thromboembolism (VTE) in pediatric patients. Study design A retrospective analysis of patients with hospital-associated VTE at the Johns Hopkins Hospital from 1994 to 2009 was performed. Clinical characteristics of patients aged 21 years and younger who developed VTE symptoms after 2 days of hospitalization or <90 days after hospital discharge were examined. International Classification of Diseases, Ninth Revision codes were used to categorize patients with complex chronic medical conditions and trauma. Results There were 270 episodes of hospital-associated VTE in 90â€̂485 admissions (rate 30 per 10â€̂000 admissions). Young adults (18-21 years) and adolescents (14-17 years) had significantly increased rates of VTE compared with children (2-9 years) (incidence rate ratio [IRR] 7.7, 95% CI 5.1-12.0; IRR 4.3, 95% CI 2.7-6.8, respectively). A central venous catheter (CVC) was present in 50% of patients, and a surgical procedure was performed in 45% of patients before VTE diagnosis. For patients without a CVC, trauma was the most common admitting diagnosis. CVC-related VTE was diagnosed most frequently in infants (<1 year old) and in patients with malignancy. Renal and cardiac diseases were associated with the highest rates of VTE (51 and 48 per 10 000, respectively). Rates were significantly higher among those with ≥4 medical conditions compared with those with 1 medical condition (IRR 4.0, 95% CI 1.4-8.9). Conclusion Older age and multiple medical conditions were associated with increased rates of hospital-associated VTE. These data can contribute to the design of future clinical trials to prevent hospital-associated VTE in high-risk children.
AB - Objective To determine incidence and clinical characteristics of hospital-associated venous thromboembolism (VTE) in pediatric patients. Study design A retrospective analysis of patients with hospital-associated VTE at the Johns Hopkins Hospital from 1994 to 2009 was performed. Clinical characteristics of patients aged 21 years and younger who developed VTE symptoms after 2 days of hospitalization or <90 days after hospital discharge were examined. International Classification of Diseases, Ninth Revision codes were used to categorize patients with complex chronic medical conditions and trauma. Results There were 270 episodes of hospital-associated VTE in 90â€̂485 admissions (rate 30 per 10â€̂000 admissions). Young adults (18-21 years) and adolescents (14-17 years) had significantly increased rates of VTE compared with children (2-9 years) (incidence rate ratio [IRR] 7.7, 95% CI 5.1-12.0; IRR 4.3, 95% CI 2.7-6.8, respectively). A central venous catheter (CVC) was present in 50% of patients, and a surgical procedure was performed in 45% of patients before VTE diagnosis. For patients without a CVC, trauma was the most common admitting diagnosis. CVC-related VTE was diagnosed most frequently in infants (<1 year old) and in patients with malignancy. Renal and cardiac diseases were associated with the highest rates of VTE (51 and 48 per 10 000, respectively). Rates were significantly higher among those with ≥4 medical conditions compared with those with 1 medical condition (IRR 4.0, 95% CI 1.4-8.9). Conclusion Older age and multiple medical conditions were associated with increased rates of hospital-associated VTE. These data can contribute to the design of future clinical trials to prevent hospital-associated VTE in high-risk children.
KW - CCC
KW - CVC
KW - Central venous catheter
KW - Complex chronic condition
KW - DVT
KW - Deep venous thrombosis
KW - HLHS
KW - Hypoplastic left heart syndrome
KW - ICD-9
KW - IRR
KW - Incidence rate ratio
KW - International Classification of Diseases, Ninth Revision
KW - PE
KW - Pulmonary embolism
KW - VTE
KW - Venous thromboembolism
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U2 - 10.1016/j.jpeds.2013.10.025
DO - 10.1016/j.jpeds.2013.10.025
M3 - Article
C2 - 24332452
AN - SCOPUS:84892782518
SN - 0022-3476
VL - 164
SP - 332
EP - 338
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 2
ER -