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Factors Associated with VTE Prophylaxis in Pediatric Trauma Patients Admitted to the ICU
Amee M. Bigelow, MD1, Katherine T. Flynn-O'Brien, MD2, Pippa Simpson, PhD3, Mahua Dasgupta, MS3, Sheila J. Hanson, MD, MS1. 1Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA, 2Department of Pediatrics, Division of Critical Care, University of Washington, Department of Surgery, Seattle, WA, 3Medical College of Wisconsin, Department of Pediatrics, Division of Quantitative Health Sciences, Milwaukee, WI, USA.

Background: Venous thromboembolism (VTE) in pediatric trauma patients admitted to pediatric intensive care units (PICUs) is not insignificant, ranging up to 6%. Little consensus of VTE prophylaxis practice in this population exists. We sought to identify factors associated with VTE prophylaxis.

Methods: All patients <18 years between January 1- December 31, 2013 from five trauma centers in the Pediatric Trauma Assessment and Management Database were evaluated for prophylactic use: mechanical(MPx), pharmacologic(PPx) or both(BOTH) compared to those with no prophylaxis. Multivariable logistic regression explored the relationship between any prophylaxis and selected covariates with stepwise selection method to find the best predictors with p<0.05 considered significant.

Results: Of 637 patients, 84.5% had no VTE prophylaxis at 48 hours, 1.7% had BOTH, 12.1% had only MPx, 1.7% had PPx alone. Multivariable analysis showed association with age and all forms of prophylaxis. Admission to the ICU post-operatively (Odds ratio(OR) 4.64 with 95% confidence interval(CI) 1.04-20.84) and lower extremity fractures (OR 12.52, 95%CI 2.38-65.85) were associated with BOTH. Orthopedic procedures were associated with PPx (OR 6.36, 95%CI 1.58-25.67) and MPx (OR 1.95, 95%CI 0.99-3.82). Brain/spinal cord injuries (OR 2.68, 95% CI 1.34-5.37) and abdominal injuries (OR 5.13, 95% CI1.93-13.63) were associated with MPx. Injury/illness severity, and co-morbidities were not significant predictors after multivariable analysis. Site variation existed for PPx and BOTH, but not for MPx.

Conclusions: Age, diagnoses, and post-operative admission are associated with VTE prophylaxis in critically ill children after trauma. Illness/injury severity is not associated with prophylaxis. Site variation exists for pharmacologic prophylaxis.


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