Julie Jaffray1, Arash Mahajerin2, Guy Young3, Neil Goldenberg4, Lingyun Ji5, Richard Sposto6, Amy Stillings7, Emily Krava7, Brian Branchford8. 1. Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, 4650 Sunset Blvd, Mailstop #54, Los Angeles, CA 90027, United States. Electronic address: jjaffray@chla.usc.edu. 2. University of California, Irvine and CHOC Children's Specialists, United States. 3. Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, United States. 4. Johns Hopkins All Children's Hospital, United States. 5. University of Southern California Keck School of Medicine, United States. 6. University of Southern California Keck School of Medicine, Children's Center for Cancer and Blood Disorders,Children's Hospital Los Angeles, United States. 7. Children's Hospital Los Angeles, United States. 8. University of Colorado School of Medicine, Children's Hospital Colorado, United States.
Abstract
BACKGROUND: Pediatric hospital-acquired venous thromboembolism (HA-VTE) rates have increased dramatically. To achieve generalizable knowledge in the derivation and validation of HA-VTE risk factors and risk prediction models and inform future risk-stratified prevention strategies, multi-institutional studies are needed. OBJECTIVES: This paper presents an investigator-initiated, multicenter pediatric case-cohort study designed to identify risk factors for HA-VTE to create a HA-VTE risk prediction model. METHODS: A registry, which houses pertinent variables from HA-VTE subjects and non-HA-VTE controls, was created for the Children's Hospital-Acquired Thrombosis (CHAT) study. Specific variables from the registry associated with HA-VTE risk will be identified using multivariable regression to create a pediatric HA-VTE risk prediction model to be prospectively validated. RESULTS: Seven large pediatric institutions have entered over 600 HA-VTE subjects aged 0-21years of age into the registry. Subjects showed a male predominance (57%), a median age of three years (IQR 0.3-13) and were most likely admitted to an intensive care unit (57%) at VTE diagnosis. Median time to HA-VTE was 10days after admission. The most prevalent risk factors include central venous catheters (80%), surgery (43%), systemic steroids (31%), congenital heart disease (27%), infection (14%) and cancer (13%). CONCLUSIONS: CHAT, with its creation of a risk prediction model with prospective validation using the CHAT registry, is a novel study design and will be the first step in identifying safe and effective strategies to decrease HA-VTE in children by helping define the highest risk population for initial, or more aggressive, thromboprophylaxis efforts.
BACKGROUND: Pediatric hospital-acquired venous thromboembolism (HA-VTE) rates have increased dramatically. To achieve generalizable knowledge in the derivation and validation of HA-VTE risk factors and risk prediction models and inform future risk-stratified prevention strategies, multi-institutional studies are needed. OBJECTIVES: This paper presents an investigator-initiated, multicenter pediatric case-cohort study designed to identify risk factors for HA-VTE to create a HA-VTE risk prediction model. METHODS: A registry, which houses pertinent variables from HA-VTE subjects and non-HA-VTE controls, was created for the Children's Hospital-Acquired Thrombosis (CHAT) study. Specific variables from the registry associated with HA-VTE risk will be identified using multivariable regression to create a pediatric HA-VTE risk prediction model to be prospectively validated. RESULTS: Seven large pediatric institutions have entered over 600 HA-VTE subjects aged 0-21years of age into the registry. Subjects showed a male predominance (57%), a median age of three years (IQR 0.3-13) and were most likely admitted to an intensive care unit (57%) at VTE diagnosis. Median time to HA-VTE was 10days after admission. The most prevalent risk factors include central venous catheters (80%), surgery (43%), systemic steroids (31%), congenital heart disease (27%), infection (14%) and cancer (13%). CONCLUSIONS: CHAT, with its creation of a risk prediction model with prospective validation using the CHAT registry, is a novel study design and will be the first step in identifying safe and effective strategies to decrease HA-VTE in children by helping define the highest risk population for initial, or more aggressive, thromboprophylaxis efforts.
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: E Vincent S Faustino; Veronika Shabanova; Leslie J Raffini; Sarah B Kandil; Simon Li; Matthew G Pinto; Jill M Cholette; Sheila J Hanson; Marianne E Nellis; Cicero T Silva; Ranjit Chima; Anjali Sharathkumar; Kimberly A Thomas; Tara McPartland; Joana A Tala; Philip C Spinella Journal: Crit Care Med Date: 2021-03-01 Impact factor: 9.296
Authors: Anthony Chan; Anthonie W A Lensing; Dagmar Kubitza; Grahaem Brown; Dolores Elorza; Marta Ybarra; Jacqueline Halton; Sebastian Grunt; Gili Kenet; Damien Bonnet; Amparo Santamaria; Paola Saracco; Tina Biss; Francesco Climent; Philip Connor; Joseph Palumbo; Kirstin Thelen; William T Smith; Amy Mason; Ivet Adalbo; Scott D Berkowitz; Eva Hurst; Jeroen van Kesteren; Guy Young; Paul Monagle Journal: Thromb J Date: 2018-11-01
Authors: Ahmed Mousa; Ossama M Zakaria; Ibrahim Hanbal; Mohammed A Nasr; Tamer A Sultan; Mohamed Abd El-Hamid; Amr M El-Gibaly; Haytham Al-Arfaj; Ahmed S Daha; Mohammed A Buhalim; Mohamed Y Zakaria; Dina E El Metwally; Bosat E Bosat; Alaa Sharabi; Mohamed Nienaa; Mahsoub M Amin; Khaled A Rashed Journal: Clin Appl Thromb Hemost Date: 2018-12-06 Impact factor: 2.389