Abstract
OBJECTIVES: To create a risk model for hospital-acquired venous thromboembolism in critically ill children upon admission to an ICU. DESIGN: Case-control study. SETTING: ICUs from eight children's hospitals throughout the United States. SUBJECTS: Critically 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. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The 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). CONCLUSIONS: Using 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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | E1-E9 |
| Journal | Pediatric Critical Care Medicine |
| Volume | 23 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2022 |
Funding
We thank for the effort and expertise of the clinical research coordinators who supported the execution of this study: Jill Bradisse (Children's Mercy Hospital), Kim Cattivelli (Boston Children's Hospital [BCH]), Allaura Cox (Children's Hospital Colorado [CHCO]), Marissa Erickson (CHOC Children's Hospital), Lori Sahakian (BCH), and Natalie Laing Smith (CHCO). We also thank the faculty and supporters of the American Society of Hematology Clinical Research Training Institute for the mentorship provided through this program to J. Jaffray in her work on this study. Dr. Jaffray received grant funding for this study from the National Institutes of Health (NIH) from the National Center for Advancing Translational Science (grant number UL1TR001855), the Children’s Hospital Saban Research Mentored Career Development Award, and The Hemostasis and Thrombosis Research Society Mentored Research Award, supported by an independent educational grant from Takeda Pharmaceuticals U.S.A. Dr. Mahajerin received grant funding from to The Hemostasis and Thrombosis Research Society Mentored Research Award and CHOC Children’s Hospital and University of California Irvine Physician-Scientist Research Award program. Dr. Goldenberg receives salary and research support from NIH National Heart, Lung, and Blood Institute (NHLBI) via a U01 award. Drs. Jaffray, Branchford, and Goldenberg received support for article research from the NIH. Dr. Branchford received funding from Kedrion, Bioproducts Lab, Biomarin, Shire, Innovative Biopharma, Advio, Bayer, and Octapharma. Drs. Branchford and Goldenberg received support for article research from the NHLBI. Dr. Silvey received funding from Genetech and Bayer. Dr. Amankwah received funding from Bristol Myers Squibb and Pfizer. Dr. Goldenberg received funding from the NIH, the NHLBI, Daiici Sankyo, Anthos Therapeutics, and the Academic Research Organization CPC Clinical Research. The remaining authors have disclosed that they do not have any potential conflicts of interest. Funding sources did not have a role in study design, data analysis, writing, or submission of the manuscript. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Keywords
- Children
- Critically ill
- Risk factor
- Risk prediction
- Venous thromboembolism
- Venous thrombosis
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Critical Care and Intensive Care Medicine