Boulet Mathieu, Langlais Tristan, Pelet Stéphane, Belzile Étienne, Forsythe Caroline
Department of Surgery, Division of Orthopaedic Surgery, CHU de Québec, Université Laval, Québec, QC, Canada.
Orthopaedic Paediatric Department, Children Hospital, CHU Purpan, Toulouse Universitary, Toulouse, France.
Orthop Traumatol Surg Res. 2025 May;111(3):103830. doi: 10.1016/j.otsr.2024.103830. Epub 2024 Feb 7.
Children undergoing orthopedic procedures often present numerous risk factors for thromboembolism. A recent survey, conducted by the Pediatric Orthopaedic Society of North America (POSNA), indicates that pediatric orthopedic surgeons are unaware of venous thromboembolism (VTE) prevention protocols and feel that certain procedures should require thromboprophylaxis. The aim of this systematic review was to properly assess the incidence of VTE in pediatric orthopedics. By using a thorough and broad search of the literature, the incidence according to different subspecialties of pediatric orthopedics was evaluated.
A systematic review on VTE in pediatric orthopedics was conducted. Four databases were searched for articles reporting these events. Three major search concepts: "pediatrics", "orthopedic surgery/trauma" and "VTE complications" were used and broken down in MeSH, EmTree and their free vocabulary synonyms for proper literature review. Two independent authors screened 8467 titles and abstracts. Seventy articles reporting VTE in children treated by orthopedic surgeons were selected for data extraction. We reported median incidences by orthopedic subtypes and by study characteristics with a semi-quantitative review model.
The 70 articles yielded a total of 845,010 participants. Spine articles (33/70) provided 25,2% of the children included in the review. Trauma studies (16/70) accounted for 47.5% of the participants. The overall VTE median incidence was 0.16% [95% CI: 0.0-1.01%]. Musculoskeletal infections had a noticeably higher median incidence of 3.5% [CI: 0.0-13.8%]. Small variations were seen for the other subtypes: trauma, spine and elective surgeries. Subgroups by article characteristics did not differ significantly either.
Thrombotic complications are rare events in pediatric orthopedics, but knowledge epidemiologic is important because its potential severity. In this review, VTE median incidence for all orthopedic subtypes was around 0.16% [CI: 0.0-1.01%]. According to subspecialty assessment, musculoskeletal infections were associated with greater risk of VTE occurrence.
III - Systematic review.
接受骨科手术的儿童通常存在众多血栓栓塞风险因素。北美小儿骨科学会（POSNA）近期开展的一项调查表明，小儿骨科医生并不了解静脉血栓栓塞（VTE）预防方案，且认为某些手术应进行血栓预防。本系统评价的目的是准确评估小儿骨科中VTE的发生率。通过全面广泛地检索文献，评估了小儿骨科不同亚专业的发生率。
对小儿骨科中的VTE进行了系统评价。检索了四个数据库以查找报告这些事件的文章。使用了三个主要检索概念：“儿科”、“骨外科/创伤”和“VTE并发症”，并在医学主题词表（MeSH）、欧洲医学检索词表（EmTree）及其自由词同义词中进行分解，以进行恰当的文献综述。两名独立作者筛选了8467篇标题和摘要。选择了70篇报告骨科医生治疗儿童VTE的文章进行数据提取。我们采用半定量综述模型报告了骨科亚型和研究特征的中位发生率。
这70篇文章共纳入845,010名参与者。脊柱相关文章（33/70）提供了纳入综述儿童的25.2%。创伤研究（16/70）占参与者的47.5%。VTE总体中位发生率为0.16%[95%置信区间：0.0 - 1.01%]。肌肉骨骼感染的中位发生率显著更高，为3.5%[置信区间：0.0 - 13.8%]。其他亚型（创伤、脊柱和择期手术）有小的差异。按文章特征划分的亚组也无显著差异。
血栓形成并发症在小儿骨科中是罕见事件，但了解其流行病学情况很重要，因为其潜在严重性。在本综述中，所有骨科亚型的VTE中位发生率约为0.16%[置信区间：0.0 - 1.01%]。根据亚专业评估，肌肉骨骼感染与VTE发生风险增加相关。
III - 系统评价。
