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J Pediatr. 2014 Oct;165(4):793-8. doi: 10.1016/j.jpeds.2014.05.053. Epub 2014 Jul 23.

Development of a new risk score for hospital-associated venous thromboembolism in noncritically ill children: findings from a large single-institutional case-control study.

Author information

1
Office of Graduate Medical Education, University of South Florida Morsani College of Medicine, Tampa, FL.
2
Clinical and Translational Research Organization, All Children's Research Institute, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL.
3
Johns Hopkins Medicine Pediatric Thrombosis Program, All Children's Hospital and Johns Hopkins Children's Center, St. Petersburg, FL and Baltimore, MD.
4
Clinical and Translational Research Organization, All Children's Research Institute, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL; Johns Hopkins Medicine Pediatric Thrombosis Program, All Children's Hospital and Johns Hopkins Children's Center, St. Petersburg, FL and Baltimore, MD.
5
Department of Pediatrics, Section of Hematology/Oncology/Bone Marrow Transplantation, University of Colorado School of Medicine Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO.
6
Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
7
Johns Hopkins Medicine Pediatric Thrombosis Program, All Children's Hospital and Johns Hopkins Children's Center, St. Petersburg, FL and Baltimore, MD; Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
8
Clinical and Translational Research Organization, All Children's Research Institute, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL; Johns Hopkins Medicine Pediatric Thrombosis Program, All Children's Hospital and Johns Hopkins Children's Center, St. Petersburg, FL and Baltimore, MD; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: neil@jhmi.edu.

Abstract

OBJECTIVE:

To determine risk factors for pediatric hospital-associated venous thromboembolism (HA-VTE) in noncritically ill children to derive a novel HA-VTE risk model for this population.

STUDY DESIGN:

Patients with HA-VTE were identified retrospectively via the electronic health record at All Children's Hospital Johns Hopkins Medicine from April 10, 2013 through January 1, 2006. Seven contemporaneous, noncritically ill control children were randomly selected for each case of HA-VTE. The association between putative risk factors and HA-VTE was estimated with ORs and 95% CIs, which were calculated using the Wald method. A P-value threshold ≤.2 was used in univariate analysis for inclusion into a multivariate (adjusted) model.

RESULTS:

Fifty cases of HA-VTE occurred in noncritically ill children. The presence of a central venous catheter (OR 27.67, 95% CI, 8.40-91.22), infection (OR 10.40, 95% CI, 3.46-31.25), and length of stay ≥4 days (OR 5.26, 95% CI, 1.74-15.88) were found to be statistically significant risk factors for HA-VTE. An 8-point risk score was derived in which scores of 8 points, 7 points, and ≤6 points corresponded to venous thromboembolism risks of 12.5%, 1.1%, and 0.1%, respectively.

CONCLUSION:

The presence of a central venous catheter, infection, and length of stay ≥4 days are significant risk factors for HA-VTE in noncritically ill children, forming the basis for a new risk score that could inform venous thromboembolism prophylaxis decision-making. These findings warrant prospective validation.

PMID:
25064163
DOI:
10.1016/j.jpeds.2014.05.053
[Indexed for MEDLINE]

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