title: Observational cohort study of pediatric inpatients with central venous catheters at "intermediate risk" of thrombosis and eligible for anticoagulant prophylaxis.
abstract: The risk of deep vein thrombosis (DVT) among hospitalized children is rising.The optimal approach to DVT prophylaxis in children is unclear. This study set out to ascertain the prevalence of DVT among pediatric inpatients who neither have contraindications to nor absolute indications for prophylactic therapy. A prospective surveillance of at-risk children plus a retrospective chart review were conducted. Patients were considered to be at risk after the first 2 days of their admission. Of 1,637 patients reviewed, 198 patients met criteria; among these, 84% did not receive prophylaxis. Of 2,354 observed days at risk for nonprophylaxed patients (including days at risk prior to initiating prophylaxis among prophlyaxed patients), there were 9 DVT events, for a rate 3.82/1,000 days observed. A total of 31 patients received prophylaxis. Three of these patients experienced a DVT. One patient had a bleeding event, hematuria. These results describe patients who may be eligible for prophylaxis and should be screened for further risk factors.
authors.affiliation: Division of Hematology/Oncology, Children's Hospital Boston, Boston, MA 02115, USA. kathy.harney@childrens.harvard.edu
authors.forename: Kathy M
authors.initials: KM
authors.lastname: Harney
authors.forename: Margaret
authors.initials: M
authors.lastname: McCabe
authors.forename: Patricia
authors.initials: P
authors.lastname: Branowicki
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Kalish
authors.forename: Ellis J
authors.initials: EJ
authors.lastname: Neufeld
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D002669:Child Welfare; D016001:Confidence Intervals; D000075202:Contraindications; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007297:Inpatients; D007362:Intensive Care Units; D008297:Male; D010371:Pediatric Nursing; D011159:Population Surveillance; D015995:Prevalence; D011446:Prospective Studies; D058996:Quality Improvement; D011787:Quality of Health Care; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000451:nursing / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants