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Screening Guidelines are Accurate in Identifying Injured Children at High Risk for Venous Thromboembolism
Rachel Landisch, MD1, Laura Cassidy, PhD1, Kristin Braun, MS, RN2, Rowena Punzalan, MD1, Sheila Hanson, MD, MS1, David Gourlay, MD1. 1Medical College of Wisconsin, Milwaukee, WI, USA, 2Children's Hospital of Wisconsin, Milwaukee, WI, USA.

Background: Venous thromboembolism (VTE) pharmacologic prophylaxis is an accepted practice in adult trauma to prevent associated morbidity, but is not standardized in injured children. We instituted screening of VTE risk factors in order to guide pharmacologic prophylaxis in pediatric trauma.

Methods: At our Level 1 trauma center, data were prospectively collected from 8/2010-8/2015, during which a VTE prophylaxis guideline was active. Pharmacologic prophylaxis was indicated for patients at high risk for VTE, defined as ≥ 4 risks, or ≥ 13 years old and critically ill. To assess the accuracy of predicting confirmed cases of VTE, stepwise logistic regression analysis was used to measure the association of number of risk factors with VTE. A receiver operating characteristic (ROC) curve measured the accuracy of the final model to predict a VTE.

Results: Of 4045 trauma patients, 26 VTE occurred in 0.1% of injured and 4% (23/588) of critically injured children. Designation of high-risk was 81% sensitive and associated with VTE (p < 0.001). In the multivariate model, risk increased proportionately with each factor; OR of 69.9 (95% CI: (15.2, 323.1) for VTE at ≥ 3 factors. The area under ROC curve was 0.90 demonstrating excellent predictive ability.

Conclusions: VTE rate increases with the number of risk factors in injured children. Guidelines to assign high-risk to patients are accurate for identifying patients who may benefit from prophylaxis.

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