Julie Jaffray1,2, Arash Mahajerin3, Brian Branchford1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17, Anh Thy H Nguyen7, E Vincent S Faustino8, Michael Silvey9, Stacy E Croteau10,11, John H Fargo13, James D Cooper14, Nihal Bakeer15, Neil A Zakai16, Amy Stillings1, Emily Krava1, Ernest K Amankwah7,16, Guy Young1,2, Neil A Goldenberg7,17. 1. Division of Hematology/Oncology/Bone Marrow Transplant, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA. 2. Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA. 3. Division of Hematology, Children's Health Orange County Children's Hospital, Orange, CA. 4. Department of Hematology/Oncology, Children's Hospital Colorado, Aurora, CO. 5. University of Colorado School of Medicine, Aurora, CO. 6. Versiti Blood Research Institute, Milwaukee, WI. 7. Data Coordinating Center, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL. 8. Department of Pediatrics, Yale School of Medicine, New Haven, CT. 9. Department of Hematology, Oncology and Blood and Marrow Transplant, Children's Mercy Hospital, Kansas City, MO. 10. Division of Hematology/Oncology, Department of Pediatrics, Boston Children's Hospital, Boston, MA. 11. Harvard Medical School, Boston, MA. 12. Department of Cancer and Blood Disorders, Akron Children's Hospital, Akron, OH. 13. Department of Hematology/Oncology, Children's Hospital of Pittsburgh, Pittsburgh, PA. 14. Indiana Hemophilia and Thrombosis Center, Indianapolis, IN. 15. Department of Medicine and Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT. 16. Departments of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. 17. Departments of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Abstract
OBJECTIVES: To create a risk model for hospital-acquired venous thromboembolism in critically ill children upon admission to an ICU. DESIGN: Case-control study. SETTING: ICUs from eight children's hospitals throughout the United States. SUBJECTS: Critically ill children with hospital-acquired venous thromboembolism (cases) 0-21 years old and similar children without hospital-acquired venous thromboembolism (controls) from January 2012 to December 2016. Children with a recent cardiac surgery, asymptomatic venous thromboembolism, or a venous thromboembolism diagnosed before ICU admission were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The multi-institutional Children's Hospital-Acquired Thrombosis registry was used to identify cases and controls. Multivariable logistic regression was used to determine the association between hospital-acquired venous thromboembolism and putative risk factors present at or within 24 hours of ICU admission to develop the final model. A total of 548 hospital-acquired venous thromboembolism cases (median age, 0.8 yr; interquartile range, 0.1-10.2) and 187 controls (median age, 2.4 yr; interquartile range, 0.2-8.3) were analyzed. In the multivariable model, recent central venous catheter placement (odds ratio, 4.4; 95% CI, 2.7-7.1), immobility (odds ratio 3.6, 95% CI, 2.1-6.2), congenital heart disease (odds ratio 2.9, 95% CI, 1.7-4.7), length of hospital stay prior to ICU admission greater than or equal to 3 days (odds ratio, 2.5; 95% CI, 1.1-5.6), and history of autoimmune/inflammatory condition or current infection (odds ratio, 2.1; 95% CI, 1.2-3.4) were each independently associated with hospital-acquired venous thromboembolism. The risk model had an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.73-0.84). CONCLUSIONS: Using the multicenter Children's Hospital-Acquired Thrombosis registry, we identified five independent risk factors for hospital-acquired venous thromboembolism in critically ill children, deriving a new hospital-acquired venous thromboembolism risk assessment model. A prospective validation study is underway to define a high-risk group for risk-stratified interventional trials investigating the efficacy and safety of prophylactic anticoagulation in critically ill children.
OBJECTIVES: To create a risk model for hospital-acquired venous thromboembolism in critically ill children upon admission to an ICU. DESIGN: Case-control study. SETTING: ICUs from eight children's hospitals throughout the United States. SUBJECTS: Critically ill children with hospital-acquired venous thromboembolism (cases) 0-21 years old and similar children without hospital-acquired venous thromboembolism (controls) from January 2012 to December 2016. Children with a recent cardiac surgery, asymptomatic venous thromboembolism, or a venous thromboembolism diagnosed before ICU admission were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The multi-institutional Children's Hospital-Acquired Thrombosis registry was used to identify cases and controls. Multivariable logistic regression was used to determine the association between hospital-acquired venous thromboembolism and putative risk factors present at or within 24 hours of ICU admission to develop the final model. A total of 548 hospital-acquired venous thromboembolism cases (median age, 0.8 yr; interquartile range, 0.1-10.2) and 187 controls (median age, 2.4 yr; interquartile range, 0.2-8.3) were analyzed. In the multivariable model, recent central venous catheter placement (odds ratio, 4.4; 95% CI, 2.7-7.1), immobility (odds ratio 3.6, 95% CI, 2.1-6.2), congenital heart disease (odds ratio 2.9, 95% CI, 1.7-4.7), length of hospital stay prior to ICU admission greater than or equal to 3 days (odds ratio, 2.5; 95% CI, 1.1-5.6), and history of autoimmune/inflammatory condition or current infection (odds ratio, 2.1; 95% CI, 1.2-3.4) were each independently associated with hospital-acquired venous thromboembolism. The risk model had an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.73-0.84). CONCLUSIONS: Using the multicenter Children's Hospital-Acquired Thrombosis registry, we identified five independent risk factors for hospital-acquired venous thromboembolism in critically ill children, deriving a new hospital-acquired venous thromboembolism risk assessment model. A prospective validation study is underway to define a high-risk group for risk-stratified interventional trials investigating the efficacy and safety of prophylactic anticoagulation in critically ill children.
Authors: Hervé Decousus; Victor F Tapson; Jean-François Bergmann; Beng H Chong; James B Froehlich; Ajay K Kakkar; Geno J Merli; Manuel Monreal; Mashio Nakamura; Ricardo Pavanello; Mario Pini; Franco Piovella; Frederick A Spencer; Alex C Spyropoulos; Alexander G G Turpie; Rainer B Zotz; Gordon Fitzgerald; Frederick A Anderson Journal: Chest Date: 2010-05-07 Impact factor: 9.410
Authors: Shilpa J Arlikar; Christie M Atchison; Ernest K Amankwah; Irmel A Ayala; Laurie A Barrett; Brian R Branchford; Michael B Streiff; Clifford M Takemoto; Neil A Goldenberg Journal: Thromb Res Date: 2015-05-03 Impact factor: 3.944
Authors: Christie M Atchison; Ernest Amankwah; Jean Wilhelm; Shilpa Arlikar; Brian R Branchford; Arabela Stock; Michael Streiff; Clifford Takemoto; Irmel Ayala; Allen Everett; Gary Stapleton; Marshall L Jacobs; Jeffrey P Jacobs; Neil A Goldenberg Journal: Cardiol Young Date: 2017-11-08 Impact factor: 1.093
Authors: Edward Vincent S Faustino; Philip C Spinella; Simon Li; Matthew G Pinto; Petronella Stoltz; Joana Tala; Mary Elizabeth Card; Veronika Northrup; Kenneth E Baker; T Rob Goodman; Lei Chen; Cicero T Silva Journal: J Pediatr Date: 2012-08-09 Impact factor: 4.406
Authors: Alexander A Boucher; Julia A Heneghan; Subin Jang; Kaitlyn A Spillane; Aaron M Abarbanell; Marie E Steiner; Andrew D Meyer Journal: Front Surg Date: 2022-06-14