Screening ultrasound for deep vein thrombosis detection in high-risk pediatric trauma.

PURPOSE

Venous thromboembolism (VTE) is a rare but significant complication among high-risk pediatric trauma patients. The NO CLOT study's primary aim was to evaluate the safety of chemical prophylaxis against VTE in high-risk pediatric trauma patients with a secondary aim of evaluating the use of screening venous duplex ultrasound (sUS) to identify deep vein thrombosis (DVT). We hypothesized that sUS would detect asymptomatic DVT at a high rate in high-risk patients.

METHODS

A prospective multi-institutional study was performed at eight level one pediatric trauma centers from 2019 to 2022. sUS was recommended 7 days after admission for all high-risk trauma patients. Univariate and multivariate analyses were performed.

RESULTS

Of 460 high-risk trauma patients, 64/341 (18.8%) remained admitted on day 7 and underwent sUS. Ten of 64 (15.6%) had a DVT identified on sUS (median of 6.5 [IQR 5.2, 7.0] days after trauma). In 277 patients still admitted on day 7 without sUS performed, 15 (5.4%) developed symptomatic DVT (median of 6.0 [IQR 3.0, 8.0] days after trauma. For the sUS cohort, 9/10 (90%) DVTs were associated with an indwelling central venous line (CVL) and occurred either without chemical prophylaxis use at all in 4/10 (40%) or when initiated more than 24-h post-trauma in 6/10 (60%).

CONCLUSIONS

In this high-risk cohort, most DVTs were identified in the first week following injury; however, the majority were asymptomatic. Use of sUS at 1-week post-injury increases DVT detection; however, the clinical consequences of asymptomatic detection of DVT remain unknown.

LEVEL OF EVIDENCE

III.