Novel risk assessment model acts on increasing hospital-acquired venous thromboembolism rates among children

A novel risk assessment model (RAM) for hospital-acquired venous thromboembolism (HA-VTE) in critically ill children identified various risk factors contributing to this event, including immobility, mechanical ventilation, and prior hospitalisation. Since the rates of HA-VTE are increasing in this population, these findings are relevant for thromboprophylactic management in practice.

In recent years, the rate of HA-VTE has been increasing in the paediatric population [1]. Dr Julie Jaffray (Rady Children’s Hospital-San Diego, CA, USA) explained: “We know that critical illness and central venous catheters are the most important risk factors, with an incidence of HA-VTE of up to 18% in patients who have both these risk factors [2].” Various RAMs for critically ill children have been distilled from single-centre studies, but have not been externally validated. The current study aimed to prospectively validate the HA-VTE RAM, a retrospectively derived multi-institutional RAM for critically ill children [3], externally in an independent cohort via the CHAT consortium [4].

Participants between 0 and 21 years of age who were admitted to a paediatric IC unit were randomly selected and enrolled in the study. In total, 3,139 participants were included in the validation analysis [4].

The incidence of HA-VTE was 2.1% in the study population. The receiver operator characteristic (ROC) of the model was 0.81 (95% CI 0.75–0.86). Factors contributing significantly to an increased risk of HA-VTE were: immobility within 24 hours of admission (OR 1.99; 95% CI 1.16–3.44; P=0.013), past medical history of cancer (OR 3.09; 95% CI 1.42–6.72; P=0.004), hospitalisation up to 30 days before the current hospitalisation (OR 1.99; 95% CI 1.14–3.47; P=0.016), mechanical ventilation within 24 hours of admission (OR 1.91; 95% CI 1.07–3.40; P=0.028), and placement of a central venous catheter within 30 days before or within 24 hours of admission (OR 4.19; 95% CI 2.38–7.38; P<0.001).

“The assessed HA-VTE RAM helps us to understand which subset of critically ill children may benefit from thromboprophylaxis measures without increasing bleeding risk,” concluded Dr Jaffray.

1. O’Brien SH, et al. Pediatrics. 2022;149(3):e2021054649.
2. Faustino EVS, et al. J Pediatr. 2013;162(2):387-391.
3. Jaffray J, et al. Pediatr Crit Care Med. 2022;23(1):e1-e9
4. Jaffray J, et al. Multicenter study of a risk assessment model for critically ill children at high-risk for hospital-acquired venous thromboembolism. Abstract 809, 65^th ASH Annual Meeting, 9–12 December 2023, San Diego, CA, USA.

 

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Posted on 7 February 20247 February 2024