Background and objectives: Hospital-associated venous thromboembolism (HA-VTE) is a leading cause of preventable in-hospital mortality in adults. Our objective was to describe HA-VTE and evaluate risk factors for its development in adults admitted to a children's hospital, which has not been previously studied. We also evaluated the performance of commonly used risk assessment tools for HA-VTE.
Methods: A case-control study was performed at a freestanding children's hospital. Cases of HA-VTE in patients ≥18 years old (2013-2017) and age-matched controls were identified. We extracted patient and HA-VTE characteristics and HA-VTE risk factors on the basis of previous literature. Thrombosis risk assessment was performed retrospectively by using established prospective adult tools (Caprini and Padua scores).
Results: Thirty-nine cases and 78 controls were identified. Upper extremities were the most common site of thrombosis (62%). Comorbid conditions were common (91.5%), and malignancy was more common among case patients than controls (P = .04). The presence of a central venous catheter (P < .01), longer length of stay (P < .01), ICU admission (P = .005), and previous admission within 30 days (P = .01) were more common among case patients when compared with controls. Median Caprini score was higher for case patients (P < .01), whereas median Padua score was similar between groups (P = .08).
Conclusions: HA-VTE in adults admitted to children's hospitals is an important consideration in a growing high-risk patient population. HA-VTE characteristics in our study were more similar to published data in pediatrics.
Copyright © 2020 by the American Academy of Pediatrics.
Conflict of interest statement
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
A multi-institutional registry of pediatric hospital-acquired thrombosis cases: The Children's Hospital-Acquired Thrombosis (CHAT) project.Thromb Res. 2018 Jan;161:67-72. doi: 10.1016/j.thromres.2017.11.019. Epub 2017 Dec 1. Thromb Res. 2018. PMID: 29207321 Clinical Trial.
Development of a new risk score for hospital-associated venous thromboembolism in critically-ill children not undergoing cardiothoracic surgery.Thromb Res. 2015 Oct;136(4):717-22. doi: 10.1016/j.thromres.2015.04.036. Epub 2015 May 3. Thromb Res. 2015. PMID: 25979250
Development of a new risk score for hospital-associated venous thromboembolism in noncritically ill children: findings from a large single-institutional case-control study.J Pediatr. 2014 Oct;165(4):793-8. doi: 10.1016/j.jpeds.2014.05.053. Epub 2014 Jul 23. J Pediatr. 2014. PMID: 25064163
Venous thromboembolism related to warm autoimmune hemolytic anemia: a case-control study.Autoimmun Rev. 2015 Nov;14(11):1023-8. doi: 10.1016/j.autrev.2015.07.001. Epub 2015 Jul 8. Autoimmun Rev. 2015. PMID: 26162301 Review.
[Clinical features of patients with venous thromboembolism: 177 case analysis in 10 years].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Apr;31(4):453-457. doi: 10.3760/cma.j.issn.2095-4352.2019.04.016. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019. PMID: 31109420 Review. Chinese.