Christie M Atchison1, Ernest Amankwah2, Jean Wilhelm3, Shilpa Arlikar4, Brian R Branchford5, Arabela Stock6, Michael Streiff7, Clifford Takemoto7, Irmel Ayala4, Allen Everett3, Gary Stapleton3, Marshall L Jacobs3, Jeffrey P Jacobs3, Neil A Goldenberg4. 1. 1Undergraduate Medical Education,Department of Pediatrics,University of South Florida Morsani College of Medicine,Tampa,Florida,United States of America. 2. 2Department of Oncology,Johns Hopkins University School of Medicine and Sidney Kimmel Cancer Center,Baltimore,Maryland,United States of America. 3. 4Johns Hopkins All Children's Heart Institute,St. Petersburg,Florida,United States of America. 4. 3Johns Hopkins All Children's Cancer and Blood Disorders Institute,St. Petersburg,Florida,United States of America. 5. 5Section of Hematology/Oncology/Bone Marrow Transplantation,Department of Pediatrics,University of Colorado School of Medicine Anschutz Medical Campus and Children's Hospital Colorado,Aurora,Colorado,United States of America. 6. 6Division of Critical Care Medicine,Rush University Medical Center,Chicago,Illinois,United States of America. 7. 7Divisions of Hematology,Departments of Pediatrics and/or Medicine,Johns Hopkins University School of Medicine,Baltimore,Maryland,United States of America.
Abstract
BACKGROUND: Paediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children's hospitals. OBJECTIVE: The aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation. METHODS: We conducted a retrospective, case-control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children's Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression. RESULTS: Among 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06-31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13-160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13-47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three factors had a markedly increased post-test probability of having hospital-associated venous thromboembolism. CONCLUSION: Major infection, infancy, and central venous catheterisation are independent risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or cardiac catheter-based intervention, which, in combination, define a high-risk group for hospital-associated venous thromboembolism.
BACKGROUND: Paediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children's hospitals. OBJECTIVE: The aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation. METHODS: We conducted a retrospective, case-control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children's Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression. RESULTS: Among 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06-31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13-160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13-47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three factors had a markedly increased post-test probability of having hospital-associated venous thromboembolism. CONCLUSION: Major infection, infancy, and central venous catheterisation are independent risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or cardiac catheter-based intervention, which, in combination, define a high-risk group for hospital-associated venous thromboembolism.
Authors: Julie Jaffray; Arash Mahajerin; Brian Branchford; Anh Thy H Nguyen; E Vincent S Faustino; Michael Silvey; Stacy E Croteau; John H Fargo; James D Cooper; Nihal Bakeer; Neil A Zakai; Amy Stillings; Emily Krava; Ernest K Amankwah; Guy Young; Neil A Goldenberg Journal: Pediatr Crit Care Med Date: 2022-01-01 Impact factor: 3.971
Authors: Santosh Kaipa; Christopher W Mastropietro; Hamza Bhai; Riad Lutfi; Matthew L Friedman; Mouhammad Yabrodi Journal: World J Cardiol Date: 2020-10-26