Atchison Christie M, Amankwah Ernest, Wilhelm Jean, Arlikar Shilpa, Branchford Brian R, Stock Arabela, Streiff Michael, Takemoto Clifford, Ayala Irmel, Everett Allen, Stapleton Gary, Jacobs Marshall L, Jacobs Jeffrey P, Goldenberg Neil A
1Undergraduate Medical Education,Department of Pediatrics,University of South Florida Morsani College of Medicine,Tampa,Florida,United States of America.
2Department of Oncology,Johns Hopkins University School of Medicine and Sidney Kimmel Cancer Center,Baltimore,Maryland,United States of America.
Cardiol Young. 2018 Feb;28(2):234-242. doi: 10.1017/S1047951117001755. Epub 2017 Nov 8.
Paediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children's hospitals.
The aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.
We conducted a retrospective, case-control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children's Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression.
Among 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06-31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13-160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13-47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three factors had a markedly increased post-test probability of having hospital-associated venous thromboembolism.
Major infection, infancy, and central venous catheterisation are independent risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or cardiac catheter-based intervention, which, in combination, define a high-risk group for hospital-associated venous thromboembolism.
儿童医院相关静脉血栓栓塞是儿童医院主要的质量和安全问题。
本研究旨在确定心胸外科手术或治疗性心导管插入术后重症患儿发生医院相关静脉血栓栓塞的危险因素。
我们对2006年至2013年期间入住美国佛罗里达州圣彼得斯堡约翰霍普金斯儿童医院心血管重症监护病房的儿童进行了一项回顾性病例对照研究。根据国际疾病分类第九版（ICD - 9）出院编码确定医院相关静脉血栓栓塞病例，并通过放射学记录审查进行验证。对于每例医院相关静脉血栓栓塞病例，我们随机选择两名同期未发生医院相关静脉血栓栓塞的心血管重症监护病房对照，并将研究人群限制为接受过心胸外科手术或治疗性心导管插入术的患者。使用单因素和多因素逻辑回归确定假定危险因素与医院相关静脉血栓栓塞之间关联的比值比和95%置信区间。
在研究期间心血管重症监护病房的2718例入院病例中，65例符合医院相关静脉血栓栓塞标准（发生率为2%）。将研究限制在接受相关手术的病例和对照中，最终研究人群为57例医院相关静脉血栓栓塞病例和76例对照。在多因素逻辑回归模型中，发现严重感染（比值比 = 5.77，95%置信区间 = 1.06 - 31.4）、年龄≤1岁（比值比 = 6.75，95%置信区间 = 1.13 - 160）和中心静脉置管（比值比 = 7.36，95%置信区间 = 1.13 - 47.8）是这些儿童发生医院相关静脉血栓栓塞的具有统计学意义的独立危险因素。具有所有这三个因素的患者发生医院相关静脉血栓栓塞的检验后概率显著增加。
严重感染、婴儿期和中心静脉置管是心胸外科手术或基于心导管介入术后重症患儿发生医院相关静脉血栓栓塞的独立危险因素，这些因素共同确定了医院相关静脉血栓栓塞的高危人群。
