Venous thromboembolic screening in pediatric trauma: A prospective cohort study of risk-stratified ultrasonography.

Autor:	Tobias J; From the Department of Surgery (J.T., D.F.L., A.D., L.S.), Oregon Health and Science University, Portland, Oregon; Division of Pediatric Surgery, Department of Surgery (A.C.), Lucile Packard Children's Hospital at Stanford, Palo Alto, California; Department of Pediatrics (L.M.), Doernbecher Children's Hospital, Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery (E.D., M.S.), Division of Pediatric Hematology and Oncology, Department of Pediatrics (K.M.H.), Division of Pediatric Critical Care, Department of Pediatrics (E.B.), Doernbecher Children's Hospital, and Division of Pediatric Surgery, Department of Surgery (R.W., N.A.H., M.A.J.), Oregon Health and Science University, Portland, Oregon., Labuz DF, Cunningham A, Dixon A, Selesner L, Moss L, Dewey E, Haley KM, Burns E, Schreiber M, Wilson R, Hamilton NA, Jafri MA
Jazyk:	angličtina
Zdroj:	The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2023 Jan 01; Vol. 94 (1), pp. 107-112. Date of Electronic Publication: 2022 Sep 26.
DOI:	10.1097/TA.0000000000003797
Abstrakt:	Background: This prospective observational cohort study evaluates risk-stratified venous thromboembolism (VTE) screening in injured children. While the reported incidence of VTE is 6% to 10% among critically injured children, there is no standard for screening. Venous thromboembolism may have long-term sequelae in children, including postthrombotic syndrome. Methods: Patients admitted to a level 1 pediatric trauma center were risk stratified for VTE using a validated prediction algorithm. Children at high risk (risk scores ≥523; i.e., ≥1% risk) received screening duplex ultrasonography. Children at moderate risk (risk scores 410-522; i.e., 0.3-0.99% risk) were screened as a comparison/control. Results: Three-hundred fifty-five children were consecutively risk stratified from October 2019 to May 2021. Forty-seven children received screening duplex ultrasounds: 21 from a high-risk cohort and 26 from a moderate-risk cohort. Four children were diagnosed with VTE in the high-risk cohort compared with seven in the moderate-risk cohort ( p = 0.53). Total incidence of VTE among screened children was 23.4% (11 of 47). Asymptomatic VTE accounted for 81.8% of all events (9 of 11). Fifty-four percent (6 of 11) of VTE were central venous catheter associated. Venous thromboembolism in surviving children resolved by 3 to 6 months with no symptoms of postthrombotic syndrome after 1 year. No cases of VTE were identified in unscreened children, yielding an institutional VTE incidence of 3.1% (11 of 355). Discussion: Risk-stratified screening demonstrates a significant incidence of asymptomatic VTE in injured children. These results may guide reevaluation of prediction algorithms developed from symptomatic VTE risk and longitudinal study of the sequelae of asymptomatic VTE. Level of Evidence: Prognostic and Epidemiological; Level III. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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