Elsevier

The Journal of Pediatrics

Volume 164, Issue 2, February 2014, Pages 332-338
The Journal of Pediatrics

Original Article
Hospital-Associated Venous Thromboembolism in Children: Incidence and Clinical Characteristics

https://doi.org/10.1016/j.jpeds.2013.10.025Get rights and content

Objective

To determine incidence and clinical characteristics of hospital-associated venous thromboembolism (VTE) in pediatric patients.

Study design

A retrospective analysis of patients with hospital-associated VTE at the Johns Hopkins Hospital from 1994 to 2009 was performed. Clinical characteristics of patients aged 21 years and younger who developed VTE symptoms after 2 days of hospitalization or <90 days after hospital discharge were examined. International Classification of Diseases, Ninth Revision codes were used to categorize patients with complex chronic medical conditions and trauma.

Results

There were 270 episodes of hospital-associated VTE in 90 485 admissions (rate 30 per 10 000 admissions). Young adults (18-21 years) and adolescents (14-17 years) had significantly increased rates of VTE compared with children (2-9 years) (incidence rate ratio [IRR] 7.7, 95% CI 5.1-12.0; IRR 4.3, 95% CI 2.7-6.8, respectively). A central venous catheter (CVC) was present in 50% of patients, and a surgical procedure was performed in 45% of patients before VTE diagnosis. For patients without a CVC, trauma was the most common admitting diagnosis. CVC-related VTE was diagnosed most frequently in infants (<1 year old) and in patients with malignancy. Renal and cardiac diseases were associated with the highest rates of VTE (51 and 48 per 10 000, respectively). Rates were significantly higher among those with ≥4 medical conditions compared with those with 1 medical condition (IRR 4.0, 95% CI 1.4-8.9).

Conclusion

Older age and multiple medical conditions were associated with increased rates of hospital-associated VTE. These data can contribute to the design of future clinical trials to prevent hospital-associated VTE in high-risk children.

Section snippets

Methods

We performed a chart review of pediatric patients (aged ≤21 years) who were hospitalized at the Johns Hopkins Hospital from 1994 to 2009. We identified patients with VTE using International Classification of Diseases, Ninth Revision (ICD-9) codes for DVT (451.11, 451.19, 45.12, 451.81, 451.82, 451.83, 451.84, 451.89, 451.9, 453.2, 453.8, 453.9, 671.30, 671.31, 671.33, 671.40, 671.42, 671.44, 671.90, 671.91, 671.92, 671.93, 671.94) and PE (415.11, 415.19, 634.6, 634.61, 634.62, 635.60, 635.61,

Results

We identified 238 patients who were 21 years and younger with 270 episodes of hospital-associated VTE among 90 485 total patient admissions from 1994 to 2009. This resulted in a total rate of 30 per 10 000 admissions, or 0.3%. One hundred eighty-five episodes of VTE were diagnosed within 90 days of a hospital discharge (rate of 20 per 10 000 or 0.2%); in 203 episodes, VTE was diagnosed after 2 days of hospital admission (rate of 22 per 10 000 or 0.2%). Hospital-associated VTE comprised 60% of

Discussion

Using the definition of hospital-associated VTE as that diagnosed ≥2 days after hospital admission, or VTE diagnosis within 90 days of hospital discharge, we found an incidence of 30 episodes per 10 000 admissions. This rate compares with an overall incidence of VTE of 19-58 episodes per 10 000 hospitalizations that has been reported in recent studies in children using national data sets.3, 4, 5 We included the patients with VTE diagnosis after discharge from the hospital, because risk of

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    The authors declare no conflicts of interest.

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