NYMC Faculty Publications
Epidemiology of Lower Extremity Deep Venous Thrombosis in Critically Ill Adolescents
DOI
10.1016/j.jpeds.2018.05.006
Journal Title
The Journal of Pediatrics
First Page
176
Last Page
183.e2
Document Type
Article
Publication Date
10-1-2018
Department
Pediatrics
Abstract
OBJECTIVE: To determine the epidemiology of lower extremity deep venous thrombosis (DVT) in critically ill adolescents, which currently is unclear. STUDY DESIGN: We performed a multicenter, prospective, cohort study. Adolescents aged 13-17 years who were admitted to 6 pediatric intensive care units and were anticipated to receive cardiopulmonary support for at least 48 hours were eligible, unless they were admitted with DVT or pulmonary embolism or were receiving or anticipated to receive therapeutic anticoagulation. While patients were in the unit, serial sonograms of the lower extremities were performed, then centrally adjudicated. Bayesian statistics were used to leverage the similarities between adults and adolescents. RESULTS: A total of 88 adolescents were enrolled, from whom 184 lower extremity sonograms were performed. Of these, 9 adolescents developed DVT, with 1 having bilateral DVT. The frequency of DVT was 12.4% (95% credible interval: 6.1%, 20.1%), which ranged from 6.3% to 19.8% with a variability of 41.0% across units. All cases of DVT occurred in adolescents who received invasive mechanical ventilation (frequency: 16.5%; 95% credible interval 8.1%, 26.6%). DVT was associated with femoral central venous catheterization (OR 15.44; 95% credible interval 1.62, 69.05) and severe illness (OR for every 0.1 increase in risk of mortality 3.11; 95% credible interval 1.19, 6.85). DVT appears to be associated with prolonged days on support. CONCLUSIONS: Our findings highlight the similarities and differences in the epidemiology of DVT between adults and adolescents. They support the conduct and inform the design of a trial of pharmacologic prophylaxis in critically ill adolescents.
Recommended Citation
Faustino, E. V., Shabanova, V., Pinto, M., Li, S., Trakas, E., Miksa, M., Gertz, S., Polikoff, L., Napolitano, M., Brudnicki, A., Tala, J., Silva, C., & THrombosis Epidemiology in Ill Adolescents (THEIA) Study Investigators. (2018). Epidemiology of Lower Extremity Deep Venous Thrombosis in Critically Ill Adolescents. The Journal of Pediatrics, 201, 176-183.e2. https://doi.org/10.1016/j.jpeds.2018.05.006
Comments
THrombosis Epidemiology in Ill Adolescents (THEIA) Study Investigators includes Simon Li, Associate Professor of Pediatrics at New York Medical College.