• Faustino Edward Vincent S EVS Department of Pediatrics, Yale School of Medicine, New Haven, CT. Electronic address: vince.faustino@yale.edu., Veronika Shabanova, Matthew G Pinto, Simon Li, Erin Trakas, Michael Miksa, Shira Gertz, Lee A Polikoff, Massimo Napolitano, Adele R Brudnicki, Joana A Tala, Cicero T Silva, and THrombosis Epidemiology in Ill Adolescents (THEIA) Study Investigators.
• Department of Pediatrics, Yale School of Medicine, New Haven, CT. Electronic address: vince.faustino@yale.edu.
• J. Pediatr. 2018 Oct 1; 201: 176-183.e2.

ObjectiveTo determine the epidemiology of lower extremity deep venous thrombosis (DVT) in critically ill adolescents, which currently is unclear.Study DesignWe performed a multicenter, prospective, cohort study. Adolescents aged 13-17 years who were admitted to 6 pediatric intensive care units and were anticipated to receive cardiopulmonary support for at least 48 hours were eligible, unless they were admitted with DVT or pulmonary embolism or were receiving or anticipated to receive therapeutic anticoagulation. While patients were in the unit, serial sonograms of the lower extremities were performed, then centrally adjudicated. Bayesian statistics were used to leverage the similarities between adults and adolescents.ResultsA total of 88 adolescents were enrolled, from whom 184 lower extremity sonograms were performed. Of these, 9 adolescents developed DVT, with 1 having bilateral DVT. The frequency of DVT was 12.4% (95% credible interval: 6.1%, 20.1%), which ranged from 6.3% to 19.8% with a variability of 41.0% across units. All cases of DVT occurred in adolescents who received invasive mechanical ventilation (frequency: 16.5%; 95% credible interval 8.1%, 26.6%). DVT was associated with femoral central venous catheterization (OR 15.44; 95% credible interval 1.62, 69.05) and severe illness (OR for every 0.1 increase in risk of mortality 3.11; 95% credible interval 1.19, 6.85). DVT appears to be associated with prolonged days on support.ConclusionsOur findings highlight the similarities and differences in the epidemiology of DVT between adults and adolescents. They support the conduct and inform the design of a trial of pharmacologic prophylaxis in critically ill adolescents.Copyright © 2018 Elsevier Inc. All rights reserved.

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