Development of a Risk Model for Pediatric Hospital-Acquired Thrombosis: A Report from the Children's Hospital-Acquired Thrombosis Consortium.

Autor: Jaffray J; Children's Hospital Los Angeles, Los Angeles, CA; University of Southern California Keck School of Medicine, Los Angeles, CA. Electronic address: jjaffray@chla.usc.edu., Branchford B; Children's Hospital Colorado, Aurora, CO; University of Colorado School of Medicine, Aurora, CO., Goldenberg N; Johns Hopkins All Children's Hospital, Baltimore, MD; Department of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD., Malvar J; Children's Hospital Los Angeles, Los Angeles, CA., Croteau SE; Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA., Silvey M; Children's Mercy Kansas City, Kansas City, MO., Fargo JH; Akron Children's Hospital, Akron, OH., Cooper JD; Children's Hospital of Pittsburgh, Pittsburgh, PA., Bakeer N; Indiana Hemophilia and Thrombosis Center, Indianapolis, IN., Sposto R; University of Southern California Keck School of Medicine, Los Angeles, CA., Ji L; University of Southern California Keck School of Medicine, Los Angeles, CA., Zakai NA; Department of Medicine, Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont Burlington, Burlington, VT., Faustino EVS; Department of Pediatrics, Yale School of Medicine, New Haven, CT., Stillings A; Children's Hospital Los Angeles, Los Angeles, CA., Krava E; Children's Hospital Los Angeles, Los Angeles, CA., Young G; Children's Hospital Los Angeles, Los Angeles, CA; University of Southern California Keck School of Medicine, Los Angeles, CA., Mahajerin A; CHOC Children's Hospital, Mission Viejo, CA.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2021 Jan; Vol. 228, pp. 252-259.e1. Date of Electronic Publication: 2020 Sep 10.
DOI: 10.1016/j.jpeds.2020.09.016
Abstrakt: Objective: To identify pertinent clinical variables discernible on the day of hospital admission that can be used to assess risk for hospital-acquired venous thromboembolism (HA-VTE) in children.
Study Design: The Children's Hospital-Acquired Thrombosis Registry is a multi-institutional registry for all hospitalized participants aged 0-21 years diagnosed with a HA-VTE and non-VTE controls. A risk assessment model (RAM) for the development of HA-VTE using demographic and clinical VTE risk factors present at hospital admission was derived using weighted logistic regression and the least absolute shrinkage and selection (Lasso) procedure. The models were internally validated using 5-fold cross-validation. Discrimination and calibration were assessed using area under the receiver operating characteristic curve and Hosmer-Lemeshow goodness of fit, respectively.
Results: Clinical data from 728 cases with HA-VTE and 839 non-VTE controls, admitted between January 2012 and December 2016, were abstracted. Statistically significant RAM elements included age <1 year and 10-22 years, cancer, congenital heart disease, other high-risk conditions (inflammatory/autoimmune disease, blood-related disorder, protein-losing state, total parental nutrition dependence, thrombophilia/personal history of VTE), recent hospitalization, immobility, platelet count >350 K/μL, central venous catheter, recent surgery, steroids, and mechanical ventilation. The area under the receiver operating characteristic curve was 0.78 (95% CI 0.76-0.80).
Conclusions: Once externally validated, this RAM will identify those who are at low-risk as well as the greatest-risk groups of hospitalized children for investigation of prophylactic strategies in future clinical trials.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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