Pulmonary embolism: which pediatric trauma patients are at risk?
OBJECTIVE
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.
Truitt
Anne K
AK
Division of Pediatric Surgery, Brown Medical School and Hasbro Children's Hospital, Providence, RI 02905, USA.
Sorrells
Donald L
DL
Halvorson
Eric
E
Starring
Jayne
J
Kurkchubasche
Arlet G
AG
Tracy
Thomas F
TF
Luks
Francois I
FI
D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012237:Rhode Island; D012307:Risk Factors; D015599:Trauma Severity Indices; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D014947:Wounds and Injuries / Q000150:complications*
D000925:Anticoagulants