Clinical and Translational Research Organization, All Children's Research Institute, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL, USA.
Undergraduate Medical Education, Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Thromb Res. 2015 Oct;136(4):717-22. doi: 10.1016/j.thromres.2015.04.036. Epub 2015 May 3.
Although risk of hospital-associated venous thromboembolism (HA-VTE) differs between critically and non-critically ill children, studies to date have not led to distinct, pragmatic risk scores.
To determine risk factors for HA-VTE in critically ill children not undergoing cardiothoracic surgery, in order to derive a novel HA-VTE risk score for this population.
We conducted a retrospective analysis from January 2006 through April 2013 at All Children's Hospital Johns Hopkins Medicine. HA-VTE cases were identified using ICD-9 discharge diagnosis codes, with subsequent validation via radiologic record review. Cases were restricted to Pediatric Intensive Care Unit (PICU) admissions. Patients who underwent cardiothoracic surgery were excluded; cardiac catheterization per se was not exclusionary. For each case, three non-HA-VTE PICU controls were randomly selected. Data were abstracted on putative risk factors, and associations between risk factors and HA-VTE were estimated using odds ratios (ORs) and 95% confidence intervals (95%CIs).
There were 57 HA-VTE cases and 171 controls. HA-VTE occurrence was 3 per 1000 PICU admissions (0.3%). Central venous catheter (CVC) (OR:26.64; 95%CI:7.46-95.13), length of stay (LOS) ≥4days (OR:20.22; 95%CI:2.27-180.07), and significant infection (OR:3.41; 95%CI:1.13-10.29) were independent, statistically-significant risk factors for HA-VTE in a multivariate model. A risk score was derived in which HA-VTE risk exceeded 2% (threshold for anticoagulant thromboprophylaxis in hospitalized adults) with a score of 15, and was >1% but <2% (risk zone for mechanical thromboprophylaxis in hospitalized adults) with scores of 7-14.
The presence of a CVC, LOS≥4days and infection are significant risk factors for HA-VTE in critically ill children not undergoing cardiothoracic surgery, forming the basis for a new risk score that warrants prospective validation.
尽管危重症患儿与非危重症患儿的医院相关性静脉血栓栓塞症（HA-VTE）风险不同，但迄今为止的研究并未得出明确的实用风险评分。
确定未行心胸外科手术的危重症患儿发生 HA-VTE 的危险因素，以便为该人群制定新的 HA-VTE 风险评分。
我们对 2006 年 1 月至 2013 年 4 月期间约翰霍普金斯儿童医疗中心所有患儿进行了回顾性分析。使用 ICD-9 出院诊断代码确定 HA-VTE 病例，随后通过放射记录审查进行验证。病例仅限于儿科重症监护病房（PICU）入院患儿。排除行心胸外科手术的患儿；心脏导管术本身并不作为排除标准。对于每个病例，随机选择 3 名非 HA-VTE 的 PICU 对照患儿。提取潜在危险因素的数据，并使用比值比（OR）和 95%置信区间（95%CI）估计危险因素与 HA-VTE 之间的关联。
共发现 57 例 HA-VTE 病例和 171 例对照患儿。PICU 患儿中 HA-VTE 发生率为 3/1000（0.3%）。中心静脉导管（CVC）（OR：26.64；95%CI：7.46-95.13）、住院时间（LOS）≥4 天（OR：20.22；95%CI：2.27-180.07）和严重感染（OR：3.41；95%CI：1.13-10.29）是多变量模型中独立的、具有统计学意义的 HA-VTE 危险因素。根据危险因素构建风险评分，评分≥15 分提示 HA-VTE 风险超过 2%（住院成人抗凝预防血栓形成的阈值），评分 7-14 分提示 HA-VTE 风险为 1%-2%（住院成人机械预防血栓形成的风险区）。
CVC 存在、LOS≥4 天和感染是未行心胸外科手术的危重症患儿发生 HA-VTE 的重要危险因素，为新的风险评分提供了依据，有待前瞻性验证。
