Risk factors for deep venous thrombosis in pediatric trauma patients: A review of the National Trauma Data Bank from 2017 to 2022.

INTRODUCTION

Pediatric trauma patients rarely receive venous thromboembolism (VTE) prophylaxis but have low rates of deep venous thrombosis (DVT). Patients with lower extremity orthopedic injuries, patients with traumatic brain injuries, more severely injured patients, and older children may be at higher risk, but these risk factors have not been examined together for a large population.

METHODS

The National Trauma Data Bank was queried from 2017 to 2022 for patients 17 years or younger and patients with DVT to create a retrospective cohort study with this subset compared with pediatric patients without DVT. Categorical variables were analyzed with χ 2 test, and continuous variables, with t test. A logistic regression model was performed to determine risk factors for DVT in pediatric trauma patients.

RESULTS

From 2017 to 2022, there were 693,729 pediatric trauma patients, of which 786 (0.11%) had a DVT. The DVT group was older (13.64 vs. 9.70 years, p < 0.0001) and more likely to be male (71.63% vs. 64.65%, p < 0.0001), proceeded immediately to operating room (41.6% vs. 14.63%, p < 0.001), received packed red blood cells (PRBCs) ≤4 hours (47.71% vs. 9.94%, p < 0.0001), received fresh frozen plasma ≤4 hours (33.46% vs. 1.22%, p < 0.0001), and had an Injury Severity Score (ISS) of >15 (87.02% vs. 43.19%, p < 0.0001). A logistic regression model demonstrated that patients age 13 years or older had an odds ratio of 2.444 (confidence interval, 1.137-5.250; p = 0.022). Other significant risk factors included PRBC ≤4 hours of arrival (odds ratio, 3.436; confidence interval, 1.574-7.502; p = 0.022), ISS of >15 (odds ratio, 3.650; confidence interval, 1.071-12.440; p < 0.038), increased lower-extremity Abbreviated Injury Scale scores (odds ratio, 1.665; confidence interval, 1.236-2.243; p = 0.001), and VTE prophylaxis administered more than 6 days after admission (odds ratio, 11.590; confidence interval, 5.695-23.584; p < 0.0001).

CONCLUSION

Venous thromboembolism prophylaxis should be considered in pediatric patients who are 13 years or older, have received PRBC early, and have severe ISS and/or higher lower-extremity Abbreviated Injury Scale score; delayed VTE prophylaxis beyond 6 hospital days increases risk of DVT in patients with these risk factors.

LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level III.