Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Original Investigation
Pacific Coast Surgical Association
January 2016

A Clinical Tool for the Prediction of Venous Thromboembolism in Pediatric Trauma Patients

Author Affiliations
  • 1Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland
  • 2Division of Biostatistics, Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland
  • 3Colon and Rectal Clinic of Houston, Department of Surgery, University of Texas, Houston
  • 4currently with the Division of Colon and Rectal Surgery, Department of Surgery, Louisiana State University, New Orleans
  • 5Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
  • 6Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Surg. 2016;151(1):50-57. doi:10.1001/jamasurg.2015.2670

Importance  Although rare, the incidence of venous thromboembolism (VTE) in pediatric trauma patients is increasing, and the consequences of VTE in children are significant. Studies have demonstrated increasing VTE risk in older pediatric trauma patients and improved VTE rates with institutional interventions. While national evidence-based guidelines for VTE screening and prevention are in place for adults, none exist for pediatric patients, to our knowledge.

Objectives  To develop a risk prediction calculator for VTE in children admitted to the hospital after traumatic injury to assist efforts in developing screening and prophylaxis guidelines for this population.

Design, Setting, and Participants  Retrospective review of 536 423 pediatric patients 0 to 17 years old using the National Trauma Data Bank from January 1, 2007, to December 31, 2012. Five mixed-effects logistic regression models of varying complexity were fit on a training data set. Model validity was determined by comparison of the area under the receiver operating characteristic curve (AUROC) for the training and validation data sets from the original model fit. A clinical tool to predict the risk of VTE based on individual patient clinical characteristics was developed from the optimal model.

Main Outcome and Measure  Diagnosis of VTE during hospital admission.

Results  Venous thromboembolism was diagnosed in 1141 of 536 423 children (overall rate, 0.2%). The AUROCs in the training data set were high (range, 0.873-0.946) for each model, with minimal AUROC attenuation in the validation data set. A prediction tool was developed from a model that achieved a balance of high performance (AUROCs, 0.945 and 0.932 in the training and validation data sets, respectively; P = .048) and parsimony. Points are assigned to each variable considered (Glasgow Coma Scale score, age, sex, intensive care unit admission, intubation, transfusion of blood products, central venous catheter placement, presence of pelvic or lower extremity fractures, and major surgery), and the points total is converted to a VTE risk score. The predicted risk of VTE ranged from 0.0% to 14.4%.

Conclusions and Relevance  We developed a simple clinical tool to predict the risk of developing VTE in pediatric trauma patients. It is based on a model created using a large national database and was internally validated. The clinical tool requires external validation but provides an initial step toward the development of the specific VTE protocols for pediatric trauma patients.