title: Use of vena cava filters in pediatric trauma patients: data from the National Trauma Data Bank.
abstract: BACKGROUND
  Placement of vena cava filters (VCFs) in high-risk adult trauma patients is a well-described intervention for prophylaxis against pulmonary embolism (PE). Few data exist regarding the use of VCFs in pediatric trauma.
  
  
  METHODS
  We performed a cross-sectional study using the National Trauma Data Bank of the American College of Surgeons. Patients 17 years old or younger were included. Data regarding demographics, injuries, hospitalization, survival, and treating institution were analyzed. The prevalence of deep vein thrombosis (DVT), PE, and VCF placement were calculated. Odds ratios (ORs) for predictors of VCF placement were determined using multivariate logistic regression.
  
  
  RESULTS
  There were 116,357 pediatric patients in the National Trauma Data Bank. VCFs were placed in 214 (0.18%) patients. VCF patients had longer mean hospital (23.99 vs. 4.12 days) and intensive care unit stays (13.65 vs. 1.12 days) and more severe injuries (mean Injury Severity Score, 30.89 vs. 9.04) than those without VCFs. Sixty-five patients had DVT, and PE was diagnosed in 28 patients, representing 0.06% and 0.02% of the cohort, respectively. University-associated teaching hospitals placed 72.4% (95% confidence interval, 65.9-78.3%) of VCFs and Level I trauma centers placed 46.3% (95% confidence interval, 39.4-53.2%) of VCFs. In multivariate analysis, significant predictors of VCF use were DVT (OR, 33.13), spinal cord injury (OR, 15.28), probability of survival (OR, 10.52), severe femur fracture (OR, 3.39), increasing age (OR, 1.99), ISS (OR, 1.05), intensive care unit stay (OR, 1.04), and length of stay (OR, 1.02). Higher Glasgow Coma Scale score decreased the likelihood of VCF use (OR, 0.87).
  
  
  CONCLUSIONS
  Placement of VCFs in pediatric trauma patients is uncommon and is associated with several characteristics of the patient, the injury, and the treating institution. Long-term VCF efficacy in pediatric trauma is not known, and application of VCFs in these patients requires further investigation.
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont 05401, USA. alan.cook@vtmednet.org
authors.forename: Alan
authors.initials: A
authors.lastname: Cook
authors.forename: Steven
authors.initials: S
authors.lastname: Shackford
authors.forename: Turner
authors.initials: T
authors.lastname: Osler
authors.forename: Frederick
authors.initials: F
authors.lastname: Rogers
authors.forename: Kennith
authors.initials: K
authors.lastname: Sartorelli
authors.forename: Benjamin
authors.initials: B
authors.lastname: Littenberg
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D016017:Odds Ratio; D015995:Prevalence; D011655:Pulmonary Embolism / Q000517:prevention & control*; D012042:Registries; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control; D014947:Wounds and Injuries / Q000150:complications*