Venous thromboembolism prophylaxis in the pediatric trauma population

Abstract

Background/purpose: The aim of this study was to review evidence-based literature addressing pertinent questions about venous thromboembolism (VTE) after traumatic injury in children.

Methods: Data were obtained from English-language articles identified through Pubmed published from 1995 until November 2012, and from bibliographies of relevant articles. Studies were included if they contributed evidence to one of the following questions. In the pediatric traumatic injury population: (1) What is the overall incidence of VTE? (2) Is age (adolescence versus pre-adolescence) associated with higher VTE incidence? (3) Which risk factors are associated with higher VTE incidence? (4) Does mechanical and/or pharmacological prophylaxis impact outcomes?

Results: Eighteen articles were included in this systematic review. The evidence regarding each question was evaluated, graded by author consensus, and summarized.

Conclusions: The overall incidence of VTE is low. Older (>13years) and more severely injured patients are at higher VTE risk. Additional factors including injury type or presence of a central venous catheter also place a patient at higher VTE risk. Implementation of a risk-based clinical practice guideline for VTE prophylaxis has been associated with reduced symptomatic VTE at one institution. Randomized, prospective trials analyzing outcomes of VTE prophylaxis in pediatric trauma victims are needed.

Keywords: CVC; Central venous catheter; DVT; ICU; IPC; ISS; KID; Kids’ Inpatient Database; LE; LMWH; Low molecular weight heparin; NPTR; NTDB; National Pediatric Trauma Registry; National Trauma Data Bank; PE; PHIS; PICU; Pediatric; Pediatric Health Information System; Pediatric intensive care unit; SCI; Trauma; VTE; Venous thromboembolism; central venous catheter; deep venous thrombosis; injury severity score; intensive care unit; intermittent pneumatic compression; low molecular weight heparin; lower extremity; pediatric intensive care unit; pulmonary embolism; spinal cord injury; venous thromboembolism.