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Cardiol Young. 2018 Feb;28(2):234-242. doi: 10.1017/S1047951117001755. Epub 2017 Nov 8.

Risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.

Author information

1
1Undergraduate Medical Education,Department of Pediatrics,University of South Florida Morsani College of Medicine,Tampa,Florida,United States of America.
2
2Department of Oncology,Johns Hopkins University School of Medicine and Sidney Kimmel Cancer Center,Baltimore,Maryland,United States of America.
3
4Johns Hopkins All Children's Heart Institute,St. Petersburg,Florida,United States of America.
4
3Johns Hopkins All Children's Cancer and Blood Disorders Institute,St. Petersburg,Florida,United States of America.
5
5Section of Hematology/Oncology/Bone Marrow Transplantation,Department of Pediatrics,University of Colorado School of Medicine Anschutz Medical Campus and Children's Hospital Colorado,Aurora,Colorado,United States of America.
6
6Division of Critical Care Medicine,Rush University Medical Center,Chicago,Illinois,United States of America.
7
7Divisions of Hematology,Departments of Pediatrics and/or Medicine,Johns Hopkins University School of Medicine,Baltimore,Maryland,United States of America.

Abstract

BACKGROUND:

Paediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children's hospitals.

OBJECTIVE:

The aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.

METHODS:

We conducted a retrospective, case-control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children's Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression.

RESULTS:

Among 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06-31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13-160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13-47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three factors had a markedly increased post-test probability of having hospital-associated venous thromboembolism.

CONCLUSION:

Major infection, infancy, and central venous catheterisation are independent risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or cardiac catheter-based intervention, which, in combination, define a high-risk group for hospital-associated venous thromboembolism.

KEYWORDS:

Venous thromboembolism; cardiac catheterisation; cardiothoracic surgery; critical illness; prevention; risk

PMID:
29115202
DOI:
10.1017/S1047951117001755
[Indexed for MEDLINE]

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