Hospital-Acquired Venous Thromboembolisms in Pediatric Patients

Hospital-acquired venous thromboembolisms (HA-VTEs) have been identified as an increasing problem in pediatric patients. HA-VTEs are associated with significant increases in morbidity and mortality. Although there are well-defined risk factors for HA-VTEs among the adult patient population, risk factors among pediatric patients are not well-established. Furthermore, HA-VTEs in pediatric patients are generally identified after a complication from the VTE has already occurred. To prevent HA-VTEs in pediatric patients, Lucile Packard Children’s Hospital (LPCH) employs the prevention guidelines developed by Solutions for Patient Safety, a national network of over 140 children’s hospitals in the United States. These guidelines are used to prevent HA-VTEs in patients over 12 and HA-VTEs not related to central venous catheters. We find, though, that the majority of LPCH patients are not covered by the current prevention guidelines. Our project seeks to identify risk factors specific to LPCH patients to inform the development of a predictive model and risk stratification tool to improve the quality of care at LPCH.

We consider risk factors for HA-VTEs in previous research: age, length of stay, service departments, presence of different central venous catheters, duration of central lines, and medications. We also explore other complication measures, including the Braden scale and its subcategories, which serve as measures of mobility status and illness severity. Finally, we control for patient demographics. When conducting univariate analyses, we find that across the different departments at LPCH, rates of HA-VTEs vary considerably. We segment the LPCH patient population based on the SPS prevention guidelines, using 12 years-old as a cutoff. HA-VTEs in the CVICU predominantly occur in younger patients while HA-VTEs in the ICU primarily occur in older patients. Preliminary multivariate analyses suggest that the presence of a central line, age, and length of stay are the most prominent risk factors for HA-VTEs among pediatric patients at LPCH.

Our next steps include completing a more rigorous multivariate analyses to better characterize risk factors for HA-VTEs and possibly incorporating other medical data, including lab values. Our work will better allow medical teams to identify which patients are at risk for HA-VTEs and increase prevention capabilities to reduce the incidence of HA-VTEs at LPCH.

We would like to thank Dr. David Scheinker, Dr. Andrew Shin, Dr. Lane Donnelly, Ling Loh, Cassie Bergero, Dylan Chodos, and Isha Thapa as well as the clinical staff and administration at LPCH who provided us with data and extensive feedback throughout our analyses and interviews.