Significant Practice Variability Exists In The Prevention Of Venous Thromboembolism In Injured Children: Results From A Joint Survey Of The Pediatric Trauma Society And The Trauma Center Association Of America
*Aaron Cunningham, *Nicholas Hamilton, Martin Schreiber, *Mubeen Jafri
Oregon Health & Science University, Portland, OR
Purpose: The purpose of this study was to characterize current practices to prevent venous thromboembolism (VTE) in children and measure adherence to recent joint consensus guidelines from the Pediatric Trauma Society and Eastern Association for the Surgery of Trauma (PTS/EAST).
Methods: An 18-question survey was sent to the membership of PTS and the Trauma Center Association of American. Responses were compared with Chi-square test.
Findings: One hundred twenty-one members completed the survey. Most respondents were from academic (84.3%), Level 1 pediatric (61.2%) trauma centers. VTE prophylaxis varied significantly between hospitals (Figure 1) with freestanding pediatric trauma centers more likely to stratify children by risk factors than adult trauma centers (p = 0.003). Awareness of PTS/EAST guidelines (57.9% overall) was not statistically different between hospital types (44% adult-only, 54% pediatric-only, 72% combined adult-pediatric, p = 0.097), though self-reported adherence to these guidelines was uniformly low (38.8%). Lastly, in 3 clinical scenarios, respondents chose VTE screening and prophylaxis plans in accordance with a prospective application of PTS/EAST guidelines in only 53.7%.
Conclusions (implications for practice): Currently no consensus regarding the prevention of VTE in pediatric trauma exists. Prospective application of PTS/EAST guidelines has been limited, likely due to poor quality of evidence and a reliance on post-injury metrics. Results of this survey suggest that further investigation is needed to define the risk of VTE in children and identify those needing intervention.
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