OBJECTIVE: There is lack of evidence to guide thromboprophylaxis in the pediatric intensive care unit. We aimed to assess current prescribing practice for pharmacologic thromboprophylaxis in critically ill children. SETTING: Pediatric intensive care units in the United States and Canada with at least ten beds. DESIGN: Cross-sectional self-administered survey of pediatric intensivists using adolescent, child, and infant scenarios. PARTICIPANTS: Pediatric intensive care unit clinical directors or section heads. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Physician leaders from 97 of 151 (64.2%) pediatric intensive care units or their designees responded to the survey. In mechanically ventilated children, 42.3% of the respondents would usually or always prescribe thromboprophylaxis for the adolescent but only 1.0% would prescribe it for the child and 1.1% for the infant. Considering all pediatric intensive care unit patients, 3.1%, 32.0%, and 44.2% of respondents would never prescribe thromboprophylaxis for the adolescent, child, and infant scenarios, respectively. These findings were significant (p < .001 for the adolescent vs. child and infant; p = .002 for child vs. infant). Other patient factors that increased the likelihood of prescribing prophylaxis to a critically ill child for all three scenarios were the presence of hypercoagulability, prior deep venous thrombosis, or a cavopulmonary anastomosis. Prophylaxis was less likely to be prescribed to patients with major bleeding or an anticipated invasive intervention. Low-molecular-weight heparin was the most commonly prescribed drug. CONCLUSIONS: In these scenarios, physician leaders in pediatric intensive care units were more likely to prescribe thromboprophylaxis to adolescents compared with children or infants, but they prescribed it less often in adolescents than is recommended by evidence-based guidelines for adults. The heterogeneity in practice we documented underscores the need for rigorous randomized trials to determine the need for thromboprophylaxis in critically ill adolescents and children.
OBJECTIVE: There is lack of evidence to guide thromboprophylaxis in the pediatric intensive care unit. We aimed to assess current prescribing practice for pharmacologic thromboprophylaxis in critically ill children. SETTING: Pediatric intensive care units in the United States and Canada with at least ten beds. DESIGN: Cross-sectional self-administered survey of pediatric intensivists using adolescent, child, and infant scenarios. PARTICIPANTS: Pediatric intensive care unit clinical directors or section heads. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Physician leaders from 97 of 151 (64.2%) pediatric intensive care units or their designees responded to the survey. In mechanically ventilated children, 42.3% of the respondents would usually or always prescribe thromboprophylaxis for the adolescent but only 1.0% would prescribe it for the child and 1.1% for the infant. Considering all pediatric intensive care unit patients, 3.1%, 32.0%, and 44.2% of respondents would never prescribe thromboprophylaxis for the adolescent, child, and infant scenarios, respectively. These findings were significant (p < .001 for the adolescent vs. child and infant; p = .002 for child vs. infant). Other patient factors that increased the likelihood of prescribing prophylaxis to a critically ill child for all three scenarios were the presence of hypercoagulability, prior deep venous thrombosis, or a cavopulmonary anastomosis. Prophylaxis was less likely to be prescribed to patients with major bleeding or an anticipated invasive intervention. Low-molecular-weight heparin was the most commonly prescribed drug. CONCLUSIONS: In these scenarios, physician leaders in pediatric intensive care units were more likely to prescribe thromboprophylaxis to adolescents compared with children or infants, but they prescribed it less often in adolescents than is recommended by evidence-based guidelines for adults. The heterogeneity in practice we documented underscores the need for rigorous randomized trials to determine the need for thromboprophylaxis in critically ill adolescents and children.
Authors: Deborah Cook; Mark Crowther; Maureen Meade; Christian Rabbat; Lauren Griffith; David Schiff; William Geerts; Gordon Guyatt Journal: Crit Care Med Date: 2005-07 Impact factor: 7.598
Authors: Stephen Couban; Michael Goodyear; Margot Burnell; Sean Dolan; Parveen Wasi; David Barnes; Darlene Macleod; Erica Burton; Pantelis Andreou; David R Anderson Journal: J Clin Oncol Date: 2005-03-14 Impact factor: 44.544
Authors: Fiona Newall; Tim Wallace; Catherine Crock; Janine Campbell; Helen Savoia; Chris Barnes; Paul Monagle Journal: J Paediatr Child Health Date: 2006-12 Impact factor: 1.954
Authors: Lesley G Mitchell; Maureen Andrew; Kim Hanna; Thomas Abshire; Jacqueline Halton; Ron Anderson; Irene Cherrick; Sunil Desai; Donald Mahoney; Patricia McCuster; John Wu; Gary Dahl; Peter Chait; Gabrielle de Veber; Kyong-Jin Lee; David Mikulis; Jeffrey Ginsberg; Cliford Way Journal: Cancer Date: 2003-01-15 Impact factor: 6.860
Authors: Edward Vincent S Faustino; Sheila Hanson; Philip C Spinella; Marisa Tucci; Sarah H O'Brien; Antonio Rodriguez Nunez; Michael Yung; Edward Truemper; Li Qin; Simon Li; Kimberly Marohn; Adrienne G Randolph Journal: Crit Care Med Date: 2014-05 Impact factor: 7.598
Authors: Sara-Jane N Onyeama; Sheila J Hanson; Mahua Dasgupta; Raymond G Hoffmann; Edward Vincent S Faustino Journal: Pediatr Crit Care Med Date: 2016-08 Impact factor: 3.624
Authors: Daniel P Kelly; Sigrid Bairdain; David Zurakowski; Brenda Dodson; Kathy M Harney; Russell W Jennings; Cameron C Trenor Journal: Pediatr Surg Int Date: 2016-06-04 Impact factor: 1.827
Authors: Åsa K M Östlund; Urban Fläring; Peter Larsson; Sylvie Kaiser; Lena Vermin; Tony Frisk; Ann Dahlberg; Jonas Berner; Åke Norberg; Andreas Andersson Journal: Eur J Pediatr Date: 2022-06-02 Impact factor: 3.860