Venous Thromboembolic Screening In Pediatric Trauma: A Prospective Cohort Study Of Risk-stratified Ultrasonography Reveals Significant Hidden Morbidity
Joseph Tobias, Aaron Cunningham, Alexandra Dixon, Daniel F. Labuz, Lori Moss, Elizabeth Dewey, Kristina Haley, Erin Burns, Martin Schreiber, Rachel Wilson, *Nicholas A. Hamilton, *Mubeen A. Jafri
Oregon Health & Science University, Portland, OR
Purpose: This prospective cohort study evaluates risk-stratified venous thromboembolism(VTE) screening in injured children. Significance: While the reported incidence of VTE is 6-10% among critically injured children, there is no standard for screening. Asymptomatic VTE is largely undiagnosed and may have long-term sequela, including post-thrombotic syndrome(PTS). Implementation: Patients admitted to a level-one pediatric trauma center were risk-stratified for VTE using a validated prediction algorithm. Children at high-risk(scores ≥523, ≥1% risk) received screening duplex ultrasonography. Children at moderate-risk(scores 410-522, 0.3-0.99% risk) were screened as a comparison/control(panels A, B). Outcomes: 355 children were consecutively risk-stratified from October 2019 to May 2021. 47 children received screening duplex: 21 from a high-risk cohort and 26 from a moderate-risk cohort. 4 children were diagnosed with VTE in the high-risk cohort compared to 7 in the moderate-risk cohort(panel C, p=0.53). Incidence of VTE among screened children was 23.4%(11/47). Asymptomatic VTE accounted for 81.8% of all events(9/11). 54.5%(6/11) of VTE were central venous catheter(CVC)-associated. 75%(6/8) of VTE in surviving children resolved by 3 months with no symptoms of PTS. No cases of VTE were identified in unscreened children. Institutional VTE incidence was 3.1%(11/355).Implications: Risk-stratified screening demonstrates a significant incidence of asymptomatic VTE in injured children that may otherwise be unrecognized. This hidden morbidity should guide enhanced screening for VTE and possible re-evaluation of prediction algorithms developed from symptomatic VTE risk.
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