Raffini Leslie, Huang Yuan-Shung, Witmer Char, Feudtner Chris
Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4399, USA.
Pediatrics. 2009 Oct;124(4):1001-8. doi: 10.1542/peds.2009-0768. Epub 2009 Sep 7.
The goals were to determine whether there has been an increase in the rate of venous thromboembolism (VTE) in pediatric tertiary care hospitals and to evaluate the use of anticoagulants in the treatment of hospitalized pediatric patients with VTE.
A retrospective cohort study of patients <18 years of age who were discharged from 35 to 40 children's hospitals (depending on the year) across the United States in 2001-2007 was performed. By using the Pediatric Health Information System administrative database, cases were assessed for discharge diagnosis codes for VTE; the use of anticoagulants was assessed by using patient-specific pharmacy files.
During the 7-year study period, in which 11 337 hospitalized patients were diagnosed with VTE, the annual rate of VTE increased by 70%, from 34 to 58 cases per 10,000 hospital admissions (P < .001). This increase was observed in neonates, infants, children, and adolescents. The majority (63%) of children with VTE had > or =1 coexisting chronic complex medical condition. Pediatric malignancy was the medical comorbid condition associated most strongly with recurrent VTE (P < .001). The proportion of children with VTE who were treated with enoxaparin increased from 29% to 49% during this time period (P < .001); the use of warfarin decreased slightly from 11.4% to 9.6% (P= .02). Increasing age was associated with increased likelihood of patients with VTE being treated with either enoxaparin or warfarin.
This multicenter study demonstrates a dramatic increase in the diagnosis of VTE at children's hospitals from 2001 to 2007.
本研究旨在确定儿科三级护理医院中静脉血栓栓塞症（VTE）的发生率是否有所增加，并评估抗凝剂在住院VTE患儿治疗中的使用情况。
对2001年至2007年期间从美国35至40家儿童医院（因年份而异）出院的18岁以下患者进行回顾性队列研究。通过使用儿科健康信息系统管理数据库，评估病例的VTE出院诊断代码；通过使用患者特定的药房档案评估抗凝剂的使用情况。
在为期7年的研究期间，11337名住院患者被诊断为VTE，VTE的年发生率增加了70%，从每10000例住院患者中的34例增至58例（P <.001）。在新生儿、婴儿、儿童和青少年中均观察到了这种增加。大多数（63%）VTE患儿患有≥1种并存的慢性复杂疾病。小儿恶性肿瘤是与复发性VTE关联最密切的合并症（P <.001）。在此期间，接受依诺肝素治疗的VTE患儿比例从29%增至49%（P <.001）；华法林的使用略有下降，从11.4%降至9.6%（P =.02）。年龄增加与VTE患者接受依诺肝素或华法林治疗的可能性增加相关。
这项多中心研究表明，2001年至2007年期间儿童医院中VTE的诊断显著增加。
