• Julie Jaffray, Arash Mahajerin, Brian Branchford, Anh Thy H Nguyen, FaustinoE Vincent SEVSDepartment of Pediatrics, Yale School of Medicine, New Haven, CT., Michael Silvey, Stacy E Croteau, John H Fargo, James D Cooper, Nihal Bakeer, Neil A Zakai, Amy Stillings, Emily Krava, Ernest K Amankwah, Guy Young, and Neil A Goldenberg.
• Division of Hematology/Oncology/Bone Marrow Transplant, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
• Pediatr Crit Care Me. 2022 Jan 1; 23 (1): e1e9e1-e9.

ObjectivesTo create a risk model for hospital-acquired venous thromboembolism in critically ill children upon admission to an ICU.DesignCase-control study.SettingICUs from eight children's hospitals throughout the United States.SubjectsCritically ill children with hospital-acquired venous thromboembolism (cases) 0-21 years old and similar children without hospital-acquired venous thromboembolism (controls) from January 2012 to December 2016. Children with a recent cardiac surgery, asymptomatic venous thromboembolism, or a venous thromboembolism diagnosed before ICU admission were excluded.InterventionsNone.Measurements And Main ResultsThe multi-institutional Children's Hospital-Acquired Thrombosis registry was used to identify cases and controls. Multivariable logistic regression was used to determine the association between hospital-acquired venous thromboembolism and putative risk factors present at or within 24 hours of ICU admission to develop the final model. A total of 548 hospital-acquired venous thromboembolism cases (median age, 0.8 yr; interquartile range, 0.1-10.2) and 187 controls (median age, 2.4 yr; interquartile range, 0.2-8.3) were analyzed. In the multivariable model, recent central venous catheter placement (odds ratio, 4.4; 95% CI, 2.7-7.1), immobility (odds ratio 3.6, 95% CI, 2.1-6.2), congenital heart disease (odds ratio 2.9, 95% CI, 1.7-4.7), length of hospital stay prior to ICU admission greater than or equal to 3 days (odds ratio, 2.5; 95% CI, 1.1-5.6), and history of autoimmune/inflammatory condition or current infection (odds ratio, 2.1; 95% CI, 1.2-3.4) were each independently associated with hospital-acquired venous thromboembolism. The risk model had an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.73-0.84).ConclusionsUsing the multicenter Children's Hospital-Acquired Thrombosis registry, we identified five independent risk factors for hospital-acquired venous thromboembolism in critically ill children, deriving a new hospital-acquired venous thromboembolism risk assessment model. A prospective validation study is underway to define a high-risk group for risk-stratified interventional trials investigating the efficacy and safety of prophylactic anticoagulation in critically ill children.Copyright © 2021 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

18 keywords...

hide…