Kumar Riten, Chen Nan, Lehman Laura L, London Wendy B
Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA.
J Pediatr. 2025 Jan;276:114328. doi: 10.1016/j.jpeds.2024.114328. Epub 2024 Sep 30.
To investigate trends in the diagnosis of venous thromboembolism (VTE) and arterial ischemic stroke (AIS), and examine the use of pharmacological thromboprophylaxis during the COVID-19 pandemic.
This retrospective cohort study used the Pediatric Health Information Systems database to investigate patients admitted to a participating hospital between January 1, 2018, and December 31, 2021. International Classification of Diseases, 10th edition codes were used to identify VTE, AIS, and COVID-19. Pharmacy billing codes were used to investigate pharmacological thromboprophylaxis use.
1 759 701 unique patients underwent 2 234 135 inpatient admissions. Rate of VTE increased from 84 cases per 10 000 admissions in 2018-2019 to 108 cases per 10 000 admissions in 2020-2021, representing a 28.6% increase (P < .001). In contrast, the rate of AIS remained stable through the study period. When compared with 2018-2019, children diagnosed with VTE during 2020-2021 had longer hospitalizations and were more likely to be admitted to the intensive care unit. When analysis was limited to 2020-2021, a diagnosis code of COVID-19 was associated with a 1.35-fold (95% CI: 1.24-1.45) increase in the odds of VTE diagnosis, but not AIS. Use of pharmacologic thromboprophylaxis increased from 1.5% of hospitalizations in 2018-2019 to 3.0% of hospitalizations in 2020-2021 (P < .001). When evaluating thromboprophylaxis during 2020-2021, a diagnosis code for COVID-19 was associated with an 11-fold (95% CI: 10.86-11.49; P < .001) increase in the utilization of pharmacological thromboprophylaxis.
This study found an increase in the rate of VTE among hospitalized children during the pandemic. A diagnosis of COVID-19 was associated with a modest increase in odds of VTE diagnosis, which occurred despite increased use of pharmacological thromboprophylaxis.
调查静脉血栓栓塞症（VTE）和动脉缺血性卒中（AIS）的诊断趋势，并研究在2019冠状病毒病（COVID-19）大流行期间药物性血栓预防的使用情况。
这项回顾性队列研究使用儿科健康信息系统数据库，调查了2018年1月1日至2021年12月31日期间入住参与研究医院的患者。使用国际疾病分类第十版编码来识别VTE、AIS和COVID-19。药房计费编码用于调查药物性血栓预防的使用情况。
1759701名不同患者接受了2234135次住院治疗。VTE的发生率从2018 - 2019年每10000次住院84例增加到2020 - 2021年每10000次住院108例，增长了28.6%（P <.001）。相比之下，在整个研究期间AIS的发生率保持稳定。与2018 - 2019年相比，2020 - 2021年诊断为VTE的儿童住院时间更长，且更有可能入住重症监护病房。当分析仅限于2020 - 2021年时，COVID-19的诊断编码与VTE诊断几率增加1.35倍（95%置信区间：1.24 - 1.45）相关，但与AIS无关。药物性血栓预防的使用从2018 - 2019年住院患者的1.5%增加到2020 - 2021年住院患者的3.0%（P <.001）。在评估2020 - 2021年期间的血栓预防时，COVID-19的诊断编码与药物性血栓预防使用率增加11倍（95%置信区间：10.86 - 11.49；P <.001）相关。
本研究发现大流行期间住院儿童中VTE的发生率有所增加。COVID-19的诊断与VTE诊断几率适度增加相关，尽管药物性血栓预防的使用有所增加，但仍出现了这种情况。
