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Venous Thromboembolism Prophylaxis in High-Risk Pediatric Trauma Patients
JAMA Surgery ( IF 15.7 ) Pub Date : 2024-07-31 , DOI: 10.1001/jamasurg.2024.2487
Amanda B Witte 1 , Kyle Van Arendonk 2 , Carisa Bergner 1 , Martin Bantchev 1 , Richard A Falcone 3 , Suzanne Moody 3 , Heather A Hartman 4 , Emily Evans 4 , Rajan Thakkar 2 , Kelli N Patterson 2 , Peter C Minneci 5 , Grace Z Mak 6 , Mark B Slidell 7 , MacKenton Johnson 6 , Matthew P Landman 8 , Troy A Markel 8 , Charles M Leys 9 , Linda Cherney Stafford 9 , Jessica Draper 9 , David S Foley 10 , Cynthia Downard 10 , Tracy M Skaggs 10 , Dave R Lal 1 , David Gourlay 1 , Peter F Ehrlich 4
Affiliation  

ImportanceThe indications, safety, and efficacy of chemical venous thromboembolism prophylaxis (cVTE) in pediatric trauma patients remain unclear. A set of high-risk criteria to guide cVTE use was recently recommended; however, these criteria have not been evaluated prospectively.ObjectiveTo examine high-risk criteria and cVTE use in a prospective multi-institutional study of pediatric trauma patients.Design, Setting, and ParticipantsThis cohort study was completed between October 2019 and October 2022 in 8 free-standing pediatric hospitals designated as American College of Surgeons level I pediatric trauma centers. Participants were pediatric trauma patients younger than 18 years who met defined high-risk criteria on admission. It was hypothesized that cVTE would be safe and reduce the incidence of VTE.ExposuresReceipt and timing of chemical VTE prophylaxis.Main Outcomes and MeasuresThe primary outcome was overall VTE rate stratified by receipt and timing of cVTE. The secondary outcome was safety of cVTE as measured by bleeding or other complications from anticoagulation.ResultsAmong 460 high-risk pediatric trauma patients, the median (IQR) age was 14.5 years (10.4-16.2 years); 313 patients (68%) were male and 147 female (32%). The median (IQR) Injury Severity Score (ISS) was 23 (16-30), and median (IQR) number of high-risk factors was 3 (2-4). A total of 251 (54.5%) patients received cVTE; 62 (13.5%) received cVTE within 24 hours of admission. Patients who received cVTE after 24 hours had more high-risk factors and higher ISS. The most common reason for delayed cVTE was central nervous system bleed (120 patients; 30.2%). There were 28 VTE events among 25 patients (5.4%). VTE occurred in 1 of 62 patients (1.6%) receiving cVTE within 24 hours, 13 of 189 patients (6.9%) receiving cVTE after 24 hours, and 11 of 209 (5.3%) who had no cVTE (P = .31). Increasing time between admission and cVTE initiation was significantly associated with VTE (odds ratio, 1.01; 95% CI, 1.00-1.01; P = .01). No bleeding complications were observed while patients received cVTE.Conclusions and RelevanceIn this prospective study, use of cVTE based on a set of high-risk criteria was safe and did not lead to bleeding complications. Delay to initiation of cVTE was significantly associated with development of VTE. Quality improvement in pediatric VTE prevention may center on timing of prophylaxis and barriers to implementation.

中文翻译:


高危儿科创伤患者的静脉血栓栓塞预防



重要性儿科创伤患者化学静脉血栓栓塞预防 (cVTE) 的适应症、安全性和有效性仍不清楚。最近推荐了一套指导 cVTE 使用的高风险标准;然而,这些标准尚未进行前瞻性评估。目的在一项针对儿科创伤患者的前瞻性多机构研究中检查高风险标准和 cVTE 的使用。设计、设置和参与者该队列研究于 2019 年 10 月至 2022 年 10 月在 8 家被指定为美国外科医师学会 I 级儿科创伤中心的独立儿科医院完成。参与者是 18 岁以下的儿科创伤患者,他们在入院时符合定义的高风险标准。据推测,cVTE 是安全的,可降低 VTE 的发生率。暴露接受化学 VTE 预防的接收和时间。主要结局和测量主要结局是按 cVTE 的接受和时间分层的总体 VTE 发生率。次要结局是通过出血或抗凝治疗的其他并发症来衡量 cVTE 的安全性。结果460 例高危儿科创伤患者中,中位 (IQR) 年龄为 14.5 岁 (10.4-16.2 岁);313 例患者 (68%) 为男性,147 例女性 (32%)。中位 (IQR) 损伤严重程度评分 (ISS) 为 23 (16-30),高危因素的中位 (IQR) 数为 3 (2-4)。共有 251 例 (54.5%) 患者接受了 cVTE;62 例 (13.5%) 在入院后 24 小时内发生 cVTE。24 小时后接受 cVTE 的患者有更多的高危因素和更高的 ISS。迟发性 cVTE 的最常见原因是中枢神经系统出血 (120 例患者;30.2%)。25 例患者中有 28 例 VTE 事件 (5.4%)。接受 cVTE 的 62 名患者中有 1 名 (1.6%) 在 24 小时内发生 VTE,189 名患者中有 13 名 (6.9%)在 24 小时后接受 cVTE,209 例中有 11 例 (5.3%) 没有 cVTE (P = .31)。入院和 cVTE 开始之间的时间增加与 VTE 显著相关 (比值比,1.01;95% CI,1.00-1.01;P = .01)。结论和相关性在这项前瞻性研究中,基于一组高风险标准使用 cVTE 是安全的,不会导致出血并发症。cVTE 开始延迟与 VTE 的发生显著相关。儿科 VTE 预防的质量提高可能集中在预防的时机和实施障碍上。
更新日期:2024-07-31
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