Scherer Andrea G, White Ian K, Shaikh Kashif A, Smith Jodi L, Ackerman Laurie L, Fulkerson Daniel H
Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, Indiana.
J Neurosurg Pediatr. 2017 Jul;20(1):71-76. doi: 10.3171/2017.3.PEDS16588. Epub 2017 May 5.
OBJECTIVE The risk of venous thromboembolism (VTE) from deep venous thrombosis (DVT) is significant in neurosurgical patients. VTE is considered a leading cause of preventable hospital deaths and preventing DVT is a closely monitored quality metric, often tied to accreditation, hospital ratings, and reimbursement. Adult protocols include prophylaxis with anticoagulant medications. Children's hospitals may adopt adult protocols, although the incidence of DVT and the risk or efficacy of treatment is not well defined. The incidence of DVT in children is likely less than in adults, although there is very little prospectively collected information. Most consider the risk of DVT to be extremely low in children 12 years of age or younger. However, this consideration is based on tradition and retrospective reviews of trauma databases. In this study, the authors prospectively evaluated pediatric patients undergoing a variety of elective neurosurgical procedures and performed Doppler ultrasound studies before and after surgery. METHODS A total of 100 patients were prospectively enrolled in this study. All of the patients were between the ages of 1 month and 12 years and were undergoing elective neurosurgical procedures. The 91 patients who completed the protocol received a bilateral lower-extremity Doppler ultrasound examination within 48 hours prior to surgery. Patients did not receive either medical or mechanical DVT prophylaxis during or after surgery. The ultrasound examination was repeated within 72 hours after surgery. An independent, board-certified radiologist evaluated all sonograms. We prospectively collected data, including potential risk factors, details of surgery, and details of the clinical course. All patients were followed clinically for at least 1 year. RESULTS There was no clinical or ultrasound evidence of DVT or VTE in any of the 91 patients. There was no clinical evidence of VTE in the 9 patients who did not complete the protocol. CONCLUSIONS In this prospective study, no DVTs were found in 91 patients evaluated by ultrasound and 9 patients followed clinically. While the study is underpowered to give a definitive incidence, the data suggest that the risk of DVT and VTE is very low in children undergoing elective neurosurgical procedures. Prophylactic protocols designed for adults may not apply to pediatric patients. Clinical trial registration no.: NCT02037607 (clinicaltrials.gov).
目的 在神经外科患者中，深静脉血栓形成（DVT）导致静脉血栓栓塞（VTE）的风险很高。VTE被认为是可预防的医院死亡的主要原因，预防DVT是一项密切监测的质量指标，通常与认证、医院评级和报销挂钩。成人方案包括使用抗凝药物进行预防。儿童医院可能采用成人方案，尽管DVT的发病率以及治疗的风险或疗效尚未明确界定。儿童DVT的发病率可能低于成人，尽管前瞻性收集的信息非常少。大多数人认为12岁及以下儿童发生DVT的风险极低。然而，这种观点是基于传统以及对创伤数据库的回顾性研究。在本研究中，作者对接受各种择期神经外科手术的儿科患者进行了前瞻性评估，并在手术前后进行了多普勒超声检查。方法 本研究前瞻性纳入了100例患者。所有患者年龄在1个月至12岁之间，均接受择期神经外科手术。完成方案的91例患者在手术前48小时内接受了双侧下肢多普勒超声检查。患者在手术期间或术后未接受药物或机械性DVT预防。术后72小时内重复进行超声检查。由一名独立的、具有委员会认证的放射科医生评估所有超声图像。我们前瞻性收集了数据，包括潜在风险因素、手术细节和临床病程细节。所有患者均接受了至少1年的临床随访。结果 91例患者中均无DVT或VTE的临床或超声证据。9例未完成方案的患者中无VTE的临床证据。结论 在这项前瞻性研究中，通过超声评估的91例患者和临床随访的9例患者中均未发现DVT。虽然该研究的样本量不足以给出确切的发病率，但数据表明接受择期神经外科手术的儿童发生DVT和VTE的风险非常低。为成人设计的预防方案可能不适用于儿科患者。临床试验注册号：NCT02037607（clinicaltrials.gov）。
