title: Survey of pharmacologic thromboprophylaxis in critically ill children.
abstract: OBJECTIVE
  There is lack of evidence to guide thromboprophylaxis in the pediatric intensive care unit. We aimed to assess current prescribing practice for pharmacologic thromboprophylaxis in critically ill children.
  
  
  METHODS
  Pediatric intensive care units in the United States and Canada with at least ten beds.
  
  
  METHODS
  Cross-sectional self-administered survey of pediatric intensivists using adolescent, child, and infant scenarios.
  
  
  METHODS
  Pediatric intensive care unit clinical directors or section heads.
  
  
  METHODS
  None.
  
  
  RESULTS
  Physician leaders from 97 of 151 (64.2%) pediatric intensive care units or their designees responded to the survey. In mechanically ventilated children, 42.3% of the respondents would usually or always prescribe thromboprophylaxis for the adolescent but only 1.0% would prescribe it for the child and 1.1% for the infant. Considering all pediatric intensive care unit patients, 3.1%, 32.0%, and 44.2% of respondents would never prescribe thromboprophylaxis for the adolescent, child, and infant scenarios, respectively. These findings were significant (p < .001 for the adolescent vs. child and infant; p = .002 for child vs. infant). Other patient factors that increased the likelihood of prescribing prophylaxis to a critically ill child for all three scenarios were the presence of hypercoagulability, prior deep venous thrombosis, or a cavopulmonary anastomosis. Prophylaxis was less likely to be prescribed to patients with major bleeding or an anticipated invasive intervention. Low-molecular-weight heparin was the most commonly prescribed drug.
  
  
  CONCLUSIONS
  In these scenarios, physician leaders in pediatric intensive care units were more likely to prescribe thromboprophylaxis to adolescents compared with children or infants, but they prescribed it less often in adolescents than is recommended by evidence-based guidelines for adults. The heterogeneity in practice we documented underscores the need for rigorous randomized trials to determine the need for thromboprophylaxis in critically ill adolescents and children.
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA. vince.faustino@yale.edu
authors.forename: Edward Vincent S
authors.initials: EV
authors.lastname: Faustino
authors.forename: Sonya
authors.initials: S
authors.lastname: Patel
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.forename: Veronika
authors.initials: V
authors.lastname: Northrup
authors.forename: Adrienne G
authors.initials: AG
authors.lastname: Randolph
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D010818:Practice Patterns, Physicians'; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects; D018709:Statistics, Nonparametric; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight