Pulmonary Embolism: Which Pediatric Trauma Patients Are at Risk?

J Pediatr Surg. 2005 Jan;40(1):124-7. doi: 10.1016/j.jpedsurg.2004.09.017.

Abstract

Background/purpose: Deep vein thrombosis and pulmonary embolism (DVT/PE) are rare in pediatric trauma patients, and guidelines for prophylaxis are scarce. The authors sought to identify subgroups of patients who may be at higher risk of developing DVT/PE.

Methods: Case-control study of pediatric trauma patients with DVT/PE. Odds ratios (ORs) and confidence intervals (CIs) were calculated for known risk factors of PE using matched trauma controls (chi2 analysis).

Results: A total of 3637 pediatric trauma patients was admitted over the last 7 years. Three patients developed DVT/PE (overall incidence, 0.08%). There were 2 girls and 1 boy, aged 15, 15, and 9 years, respectively. All 3 had an Injury Severity Score (ISS) > or =25 and an initial Glasgow Coma Score (GCS) < or =8. None of the known and potential risk factors significantly increased the OR for developing DVT/PE: age 9 years or older (OR, 3.6; CI, 0.4-26), presence of head injury (OR, 2.9; CI, 0.3-22), female sex (OR, 1.2; CI, 0.15-9.1), GCS < or =8 (OR, 9.2; CI, 0.9-230), except ISS > or =25 (OR, 82; CI, 7.6-2058). The OR for a combination of age and GCS was 106, and the OR for the 3 risk factors (age, ISS, GCS) common to all 3 patients was 114 (CI, 10-5000; P < .001).

Conclusions: The overall incidence of DVT/PE in pediatric trauma patients is <0.1% and routine prophylaxis is not recommended. Children aged 9 years or older with an initial GCS < or =8 and patients with an estimated ISS > or =25 may constitute a high-risk group in which prophylaxis could be considered.

MeSH terms

  • Adolescent
  • Anticoagulants / therapeutic use
  • Case-Control Studies
  • Child
  • Confidence Intervals
  • Female
  • Humans
  • Incidence
  • Male
  • Odds Ratio
  • Pulmonary Embolism / epidemiology*
  • Pulmonary Embolism / etiology
  • Pulmonary Embolism / prevention & control
  • Rhode Island
  • Risk Factors
  • Trauma Severity Indices
  • Venous Thrombosis / epidemiology*
  • Venous Thrombosis / etiology
  • Venous Thrombosis / prevention & control
  • Wounds and Injuries / complications*

Substances

  • Anticoagulants