The role of clinically significant venous thromboembolism and thromboprophylaxis in pediatric patients with pelvic or femoral fractures

Lark J. Greenwald, Mary Teresa Yost, Paul David Sponseller, Fizan Abdullah, Susan M. Ziegfeld, Michael Ain

Research output: Contribution to journalArticle

Abstract

Background: In adults, pelvic and femoral fractures have a known association with venous thromboembolic disease and, thus, thromboprophylaxis is the standard of care. However, similar data for children are scarce, and recommendations for pediatric prophylaxis are less clear. Our goals were to: (1) analyze the predisposing risk factors, prevalence, and outcome (including mortality) of clinically significant venous thromboembolism; (2) investigate the use of thromboprophylaxis in pediatric trauma patients and ages at which it was given; and (3) determine the impact that central venous catheters had on the occurrence of venous thromboembolism. Methods: We reviewed the records of all pediatric patients with pelvic or femoral fracture admitted to our hospital from 1990 through 2009 for occurrence of venous thromboembolism and related mortality, use and effect of central venous catheters, use of thromboprophylaxis (heparin, warfarin, enoxaparin, or factor-X inhibitors), and patient age at administration. Of the 1782 patients, 948 had electronically searchable medication (and device) records. Ninety-five percent confidence intervals were found for all proportions with sample sizes >100, and an unpaired t test was used to compare the average age at which thromboprophylaxis was given with the average age of the total population. Results: Of the 1782 patients, there were 3 (0.17%) diagnoses of deep vein thrombosis and no diagnoses of pulmonary embolism; there was no related mortality. Of the medication subset (948 patients) only 83 (8.8%) received some type of thromboprophylaxis. The average age of patients given thromboprophylaxis was 14.65 years (SD, 2.34). No central venous catheter was associated with any of the patients who had a venous thromboembolic event. Conclusions: Thromboprophylaxis was used only occasionally at our institution; >91% of patients did not receive such treatment. No morbidity or mortality was reported related to venous thromboembolism in pediatric patients with femur or pelvic fracture for whom thromboprophylaxis was used. Level of Evidence: Level II, retrospective study.

Original languageEnglish (US)
Pages (from-to)357-361
Number of pages5
JournalJournal of Pediatric Orthopaedics
Volume32
Issue number4
DOIs
StatePublished - Jun 2012

Fingerprint

Femoral Fractures
Venous Thromboembolism
Pediatrics
Central Venous Catheters
Mortality
Enoxaparin
Factor X
Warfarin
Standard of Care
Pulmonary Embolism
Venous Thrombosis
Causality
Sample Size
Femur
Heparin
Retrospective Studies
Confidence Intervals
Morbidity
Equipment and Supplies

Keywords

  • Deep venous thrombosis
  • Pediatric
  • Pulmonary embolism
  • Thromboprophylaxis
  • Trauma

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

The role of clinically significant venous thromboembolism and thromboprophylaxis in pediatric patients with pelvic or femoral fractures. / Greenwald, Lark J.; Yost, Mary Teresa; Sponseller, Paul David; Abdullah, Fizan; Ziegfeld, Susan M.; Ain, Michael.

In: Journal of Pediatric Orthopaedics, Vol. 32, No. 4, 06.2012, p. 357-361.

Research output: Contribution to journalArticle

@article{b47713c96620434ba85823057de6a453,
title = "The role of clinically significant venous thromboembolism and thromboprophylaxis in pediatric patients with pelvic or femoral fractures",
abstract = "Background: In adults, pelvic and femoral fractures have a known association with venous thromboembolic disease and, thus, thromboprophylaxis is the standard of care. However, similar data for children are scarce, and recommendations for pediatric prophylaxis are less clear. Our goals were to: (1) analyze the predisposing risk factors, prevalence, and outcome (including mortality) of clinically significant venous thromboembolism; (2) investigate the use of thromboprophylaxis in pediatric trauma patients and ages at which it was given; and (3) determine the impact that central venous catheters had on the occurrence of venous thromboembolism. Methods: We reviewed the records of all pediatric patients with pelvic or femoral fracture admitted to our hospital from 1990 through 2009 for occurrence of venous thromboembolism and related mortality, use and effect of central venous catheters, use of thromboprophylaxis (heparin, warfarin, enoxaparin, or factor-X inhibitors), and patient age at administration. Of the 1782 patients, 948 had electronically searchable medication (and device) records. Ninety-five percent confidence intervals were found for all proportions with sample sizes >100, and an unpaired t test was used to compare the average age at which thromboprophylaxis was given with the average age of the total population. Results: Of the 1782 patients, there were 3 (0.17{\%}) diagnoses of deep vein thrombosis and no diagnoses of pulmonary embolism; there was no related mortality. Of the medication subset (948 patients) only 83 (8.8{\%}) received some type of thromboprophylaxis. The average age of patients given thromboprophylaxis was 14.65 years (SD, 2.34). No central venous catheter was associated with any of the patients who had a venous thromboembolic event. Conclusions: Thromboprophylaxis was used only occasionally at our institution; >91{\%} of patients did not receive such treatment. No morbidity or mortality was reported related to venous thromboembolism in pediatric patients with femur or pelvic fracture for whom thromboprophylaxis was used. Level of Evidence: Level II, retrospective study.",
keywords = "Deep venous thrombosis, Pediatric, Pulmonary embolism, Thromboprophylaxis, Trauma",
author = "Greenwald, {Lark J.} and Yost, {Mary Teresa} and Sponseller, {Paul David} and Fizan Abdullah and Ziegfeld, {Susan M.} and Michael Ain",
year = "2012",
month = "6",
doi = "10.1097/BPO.0b013e31824b2a07",
language = "English (US)",
volume = "32",
pages = "357--361",
journal = "Journal of Pediatric Orthopaedics",
issn = "0271-6798",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - The role of clinically significant venous thromboembolism and thromboprophylaxis in pediatric patients with pelvic or femoral fractures

AU - Greenwald, Lark J.

AU - Yost, Mary Teresa

AU - Sponseller, Paul David

AU - Abdullah, Fizan

AU - Ziegfeld, Susan M.

AU - Ain, Michael

PY - 2012/6

Y1 - 2012/6

N2 - Background: In adults, pelvic and femoral fractures have a known association with venous thromboembolic disease and, thus, thromboprophylaxis is the standard of care. However, similar data for children are scarce, and recommendations for pediatric prophylaxis are less clear. Our goals were to: (1) analyze the predisposing risk factors, prevalence, and outcome (including mortality) of clinically significant venous thromboembolism; (2) investigate the use of thromboprophylaxis in pediatric trauma patients and ages at which it was given; and (3) determine the impact that central venous catheters had on the occurrence of venous thromboembolism. Methods: We reviewed the records of all pediatric patients with pelvic or femoral fracture admitted to our hospital from 1990 through 2009 for occurrence of venous thromboembolism and related mortality, use and effect of central venous catheters, use of thromboprophylaxis (heparin, warfarin, enoxaparin, or factor-X inhibitors), and patient age at administration. Of the 1782 patients, 948 had electronically searchable medication (and device) records. Ninety-five percent confidence intervals were found for all proportions with sample sizes >100, and an unpaired t test was used to compare the average age at which thromboprophylaxis was given with the average age of the total population. Results: Of the 1782 patients, there were 3 (0.17%) diagnoses of deep vein thrombosis and no diagnoses of pulmonary embolism; there was no related mortality. Of the medication subset (948 patients) only 83 (8.8%) received some type of thromboprophylaxis. The average age of patients given thromboprophylaxis was 14.65 years (SD, 2.34). No central venous catheter was associated with any of the patients who had a venous thromboembolic event. Conclusions: Thromboprophylaxis was used only occasionally at our institution; >91% of patients did not receive such treatment. No morbidity or mortality was reported related to venous thromboembolism in pediatric patients with femur or pelvic fracture for whom thromboprophylaxis was used. Level of Evidence: Level II, retrospective study.

AB - Background: In adults, pelvic and femoral fractures have a known association with venous thromboembolic disease and, thus, thromboprophylaxis is the standard of care. However, similar data for children are scarce, and recommendations for pediatric prophylaxis are less clear. Our goals were to: (1) analyze the predisposing risk factors, prevalence, and outcome (including mortality) of clinically significant venous thromboembolism; (2) investigate the use of thromboprophylaxis in pediatric trauma patients and ages at which it was given; and (3) determine the impact that central venous catheters had on the occurrence of venous thromboembolism. Methods: We reviewed the records of all pediatric patients with pelvic or femoral fracture admitted to our hospital from 1990 through 2009 for occurrence of venous thromboembolism and related mortality, use and effect of central venous catheters, use of thromboprophylaxis (heparin, warfarin, enoxaparin, or factor-X inhibitors), and patient age at administration. Of the 1782 patients, 948 had electronically searchable medication (and device) records. Ninety-five percent confidence intervals were found for all proportions with sample sizes >100, and an unpaired t test was used to compare the average age at which thromboprophylaxis was given with the average age of the total population. Results: Of the 1782 patients, there were 3 (0.17%) diagnoses of deep vein thrombosis and no diagnoses of pulmonary embolism; there was no related mortality. Of the medication subset (948 patients) only 83 (8.8%) received some type of thromboprophylaxis. The average age of patients given thromboprophylaxis was 14.65 years (SD, 2.34). No central venous catheter was associated with any of the patients who had a venous thromboembolic event. Conclusions: Thromboprophylaxis was used only occasionally at our institution; >91% of patients did not receive such treatment. No morbidity or mortality was reported related to venous thromboembolism in pediatric patients with femur or pelvic fracture for whom thromboprophylaxis was used. Level of Evidence: Level II, retrospective study.

KW - Deep venous thrombosis

KW - Pediatric

KW - Pulmonary embolism

KW - Thromboprophylaxis

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=84861417214&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861417214&partnerID=8YFLogxK

U2 - 10.1097/BPO.0b013e31824b2a07

DO - 10.1097/BPO.0b013e31824b2a07

M3 - Article

VL - 32

SP - 357

EP - 361

JO - Journal of Pediatric Orthopaedics

JF - Journal of Pediatric Orthopaedics

SN - 0271-6798

IS - 4

ER -