Allen Casey J, Murray Clark R, Meizoso Jonathan P, Ray Juliet J, Neville Holly L, Schulman Carl I, Namias Nicholas, Sola Juan E, Proctor Kenneth G
Division of Trauma and Surgical Critical Care, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Division of Pediatric Surgery, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
J Pediatr Surg. 2016 Jan;51(1):168-71. doi: 10.1016/j.jpedsurg.2015.10.033. Epub 2015 Oct 23.
BACKGROUND/PURPOSE: The purposes of this study were to identify independent predictors of venous thromboembolism (VTE), to evaluate the relative impact of adult VTE risk factors, and to identify a pediatric population at high-risk for VTE after trauma.
1934 consecutive pediatric admissions (≤ 17 years) from 01/2000 to 12/2012 at a level 1 trauma center were reviewed. Logistic regression was used to identify predictors of VTE.
Twenty-two patients (1.2%) developed a VTE, including 5% of those requiring orthopedic surgery, 14% of those with major vascular injury (MVI), and 36% of those with both. Most (84%) were diagnosed at the primary site of injury. 86% of those who developed a VTE were receiving thromboprophylaxis at the time of diagnosis. Independent predictors were age (odds ratio (OR): 1.59, 95% confidence interval (CI): 1.11-2.25), orthopedic surgery (OR: 8.10, CI: 3.10-21.39), transfusion (OR: 3.37, CI: 1.26-8.99), and MVI (OR: 15.43, CI: 5.70-41.76). When known risk factors for VTE in adults were adjusted, significant factors were age ≥ 13 years (OR: 9.16, CI: 1.08-77.89), indwelling central venous catheter (OR: 4.41, CI: 1.31-14.82), orthopedic surgery (OR: 6.80, CI: 2.47-18.74), and MVI (OR: 14.41, CI: 4.60-45.13).
MVI and orthopedic surgery are synergistic predictors of pediatric VTE. Most children who developed a VTE were receiving thromboprophylaxis at the time of diagnosis.
背景/目的：本研究的目的是确定静脉血栓栓塞症（VTE）的独立预测因素，评估成人VTE危险因素的相对影响，并确定创伤后VTE高危的儿科人群。
回顾了2000年1月至2012年12月在一家一级创伤中心连续收治的1934例儿科患者（≤17岁）。采用逻辑回归分析确定VTE的预测因素。
22例患者（1.2%）发生VTE，其中需要骨科手术的患者中5%发生VTE，有重大血管损伤（MVI）的患者中14%发生VTE，两者兼具的患者中36%发生VTE。大多数（84%）在损伤的原发部位被诊断。发生VTE的患者中86%在诊断时正在接受血栓预防治疗。独立预测因素为年龄（比值比（OR）：1.59，95%置信区间（CI）：1.11 - 2.25）、骨科手术（OR：8.10，CI：3.10 - 21.39）、输血（OR：3.37，CI：1.26 - 8.99）和MVI（OR：15.43，CI：5.70 - 41.76）。对成人已知的VTE危险因素进行调整后，显著因素为年龄≥13岁（OR：9.16，CI：1.08 - 77.89）、留置中心静脉导管（OR：4.41，CI：1.31 - 14.82）、骨科手术（OR：6.80，CI：2.47 - 18.74）和MVI（OR：14.41，CI：4.60 - 45.13）。
MVI和骨科手术是儿科VTE的协同预测因素。大多数发生VTE的儿童在诊断时正在接受血栓预防治疗。
