title: Preventing venous thrombosis in critically ill children: what is the right approach?
abstract: BACKGROUND
  The incidence of venous thromboembolic (VTE) events in children has increased in recent years (J Neurosurg, 101, 2004, 32; J Thromb Haemost, 1, 2003, 1443) yet there is currently no consensus as to what VTE prophylaxis, if any, should be applied to the pediatric population.
  
  
  OBJECTIVE
  Our aim was to audit current practice in pediatric VTE prophylaxis across England and Wales and to advocate simple measures for prevention. We illustrate the importance of the condition with a series of cases from the South West Paediatric Burns and Neurosurgical Services based in Bristol.
  
  
  METHODS
  Every pediatric intensive care unit (PICU) and burns center admitting children in England and Wales was invited to participate in a structured telephone questionnaire designed to find out how VTE in children were being prevented. We performed a literature review of specific risk factors and management of these factors.
  
  
  RESULTS
  Only one of the 24 units surveyed had written guidelines specific for children. Four other units used modified adult guidelines in older children. In the remaining 19 units that had no written guidelines, decisions regarding prophylaxis were based on individual cases and consultant-led.
  
  
  CONCLUSIONS
  There is no consensus in England and Wales as to which VTE prophylactic measures should be applied in patients <18 years of age. The National Institute for Health and Clinical Excellence (NICE) guidelines apply to adults only. Given the rarity of VTE events in children, it is unlikely that randomized controlled trials will provide the answer. We therefore propose that simple empirical measures be formally implemented in critically ill children to reduce the risk of developing this important but under-recognized condition.
authors.affiliation: Department of Anaesthesia, South West Paediatric Burns and Neuroscience Services, Frenchay Hospital, North Bristol NHS Trust, Bristol, UK.
authors.forename: Alice J
authors.initials: AJ
authors.lastname: Braga
authors.forename: Amber E R
authors.initials: AE
authors.lastname: Young
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D002056:Burns / Q000628:therapy; D003399:Craniotomy; D016638:Critical Illness; D004739:England; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D006955:Hypernatremia / Q000150:complications; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D012307:Risk Factors; D012308:Risk Management; D018805:Sepsis / Q000150:complications; D013203:Staphylococcal Infections / Q000150:complications; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D014852:Wales
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight