Feeney Erin, Morgan Katrina M, Furman Leah, Gaines Barbara A, Leeper Christine M
From the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (E.F., K.M.M., L.F., C.M.L.), University of Pittsburgh Medical Center; and Department of Surgery (B.A.G.), University of Texas Southwestern.
J Trauma Acute Care Surg. 2025 Sep 1;99(3):382-386. doi: 10.1097/TA.0000000000004670. Epub 2025 Jun 13.
We aim to evaluate the relationship between timing of venous thromboembolism (VTE) prophylaxis initiation and incidence of VTE in a high-risk cohort of injured children.
This is a retrospective analysis of the Acute Care Surgery Trauma Quality Improvement Program database (2020-2022). Injured children (younger than 18 years) who received blood products or underwent hemorrhage control surgery within 4 hours of arrival were included. The primary outcome was VTE (deep venous thrombosis or pulmonary embolism). Multivariable analysis assessed the relationship between timing of VTE prophylaxis and VTE, adjusting for prophylaxis agent, type of surgery, head injury severity, interfacility transfer, total 4-hour blood product administration, injury mechanism, Injury Severity Score, age, sex, and trauma center level, clustered by facility. Missing data were imputed. Subgroup analyses include age younger than 15 years.
Of 4,575 children included, 3,902 underwent hemorrhage control surgery, and 4,141 received blood product transfusion. In total, 185 (4%) developed VTE (n = 154 deep venous thrombosis and/or n = 45 pulmonary embolism). The VTE cohort was older (16 [15-17] vs. 16 [13-17] years), had higher Injury Severity Score (27 [19-36] vs. 25 [14-35]), and was more likely to be in shock on arrival based on shock index, pediatric age-adjusted score (75% vs. 64%). The rate of prophylaxis was 51%, with common agents being low-molecular-weight heparin (38%) and unfractionated heparin (11%). The median (interquartile range) time to initiation of prophylaxis was 2 (2-4) days. In the multivariable analysis, every 1-day delay to initiation of VTE prophylaxis was associated with 6% increase in odds of VTE (odds ratio [95% confidence interval], 1.06 [1.03-1.10]; p < 0.001). In a subset of children younger than 15 years with VTE incidence of 3%, this relationship persisted (every 1-day delay = 4% increase in odds of VTE; odds ratio, 1.04 [1.01-1.07]; p = 0.04).
Earlier VTE prophylaxis initiation was associated with decreased odds of VTE development in this high-risk pediatric cohort, highlighting opportunities to optimize VTE prevention. Future multicenter studies regarding safety and therapeutic agent of choice are required.
Therapeutic/Care Management; Level III.
我们旨在评估受伤儿童高危队列中静脉血栓栓塞症（VTE）预防起始时间与VTE发生率之间的关系。
这是一项对急性护理外科创伤质量改进计划数据库（2020 - 2022年）的回顾性分析。纳入在到达后4小时内接受血液制品或进行出血控制手术的受伤儿童（年龄小于18岁）。主要结局是VTE（深静脉血栓形成或肺栓塞）。多变量分析评估了VTE预防起始时间与VTE之间的关系，并对预防药物、手术类型、头部损伤严重程度、机构间转运、4小时内血液制品总用量、损伤机制、损伤严重程度评分、年龄、性别和创伤中心级别进行了调整，按机构进行聚类。对缺失数据进行了插补。亚组分析包括年龄小于15岁的儿童。
在纳入的4575名儿童中，3902名接受了出血控制手术，4141名接受了血液制品输血。共有185名（4%）发生了VTE（n = 154例深静脉血栓形成和/或n = 45例肺栓塞）。发生VTE的队列年龄更大（16 [15 - 17]岁 vs. 16 [13 - 17]岁），损伤严重程度评分更高（27 [19 - 36] vs. 25 [14 - 35]），根据休克指数、儿科年龄调整评分，到达时更有可能处于休克状态（75% vs. 64%）。预防率为51%，常用药物为低分子肝素（38%）和普通肝素（11%）。预防起始的中位（四分位间距）时间为2（2 - 4）天。在多变量分析中，VTE预防起始每延迟1天，VTE发生几率增加6%（优势比[95%置信区间]，1.06 [1.03 - 1.10]；p < 0.001）。在年龄小于15岁、VTE发生率为3%的儿童亚组中，这种关系仍然存在（每延迟1天 = VTE发生几率增加4%；优势比，1.04 [1.01 - 1.07]；p = 0.04）。
在这个高危儿科队列中，更早开始VTE预防与VTE发生几率降低相关，突出了优化VTE预防的机会。未来需要关于安全性和首选治疗药物的多中心研究。
治疗/护理管理；三级。
