Deep venous thrombosis in children and adolescents.
OBJECTIVE
The objective of this retrospective review was to identify patients on the pediatric neurosurgical ward with deep venous thrombosis (DVT) to develop diagnostic and treatment-related guidelines.


METHODS
The authors performed a retrospective chart review of all cases of DVT presenting to the Children's Hospital between March 1986 and February 1997. Of 32 patients identified, 14 were followed by the neurosurgical service. Current records were additionally evaluated to assess follow-up condition in the patients as well as outcome. Variables included diagnosis, race, age, follow-up duration, outcome, presenting signs/symptoms, involved vessel(s), concurrent disease, diagnostic modalities, and treatment. Patient age ranged from 1 to 16 years (mean 12.6 years, median 15 years). There were five girls and nine boys. Eight DVTs were right sided and six were left sided. Presenting symptoms included swelling of the affected extremity in 11 patients, pain in five, erythema in one, and cardiopulmonary arrest in two. Comorbidities included previous orthopedic procedures in three, brain tumors in two, and sepsis, fracture, pulmonary disease, preexisting coagulation disorders, and brain abscess in one patient each. Eight patients presented with a history of trauma. Two patients had undergone chemotherapy. Diagnostic studies included ultrasonography and venography in one, venography alone in two, computerized tomography (CT) scanning and venography in one, tagged red blood cell studies in one, ultrasonography and CT scanning in one, and ultrasonography alone in eight. In one patient an inferior vena cava filter was placed and one patient was treated with oral warfarin alone. One patient with a brain tumor died while hospitalized. In four patients there was evidence of rheumatological disease in the group of patients not treated neurosurgically. Two patients suffered recurrences during the follow-up period (mean 20 months) In the entire series of 32 patients there were five total deaths. Of these, two patients experienced six recurrences each, and one other patient suffered four recurrences. Of note, none of the recurrences was observed in patients with underlying coagulation disorders.


CONCLUSIONS
Children with DVT can experience serious complications in the form of both morbidity and mortality. Although most thrombotic complications have been found in patients with femoral lines, prolonged treatment involving a central line has been found to be a significant predictor of DVT. Multiple treatment modalities currently exist for children with DVT. Low-molecular-weight heparin therapy has many benefits over unfractionated heparin agents and may be more appropriate for the prophylaxis or treatment of children and adolescents with DVT because of its acceptable safety and efficacy. Clinical data for neonates and young children remain incomplete.
Levy
Michael L
ML
Department of Neurosurgery, Childrens Specialists of San Diego, and University of California, San Diego, California 92123, USA. mlevy@chsd.org
Granville
Robert C
RC
Hart
David
D
Meltzer
Hal
H
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight