title: Risk-prediction tool for identifying hospitalized children with a predisposition for development of venous thromboembolism: Peds-Clot clinical Decision Rule.
abstract: BACKGROUND
  The prevalence of VTE is increasing in tertiary pediatric hospitals. Identification of high-risk populations using uniform criteria is required to develop evidence-based VTE prevention guidelines.
  
  
  OBJECTIVE
  To develop a VTE risk prediction rule, the Peds-Clot clinical Decision Rule (PCDR), to identify high-risk children who were at increased risk of developing VTE.
  
  
  METHODS
  This retrospective case-control study developed the PCDR using a derivation cohort (173 cases, 346 controls) and validated it on a separate validation cohort (100 cases, 100 controls). A uniform data collection strategy was applied to derive both the samples. Conditional logistic regression analyses were used to develop a risk-prediction model. Each significant predictor was assigned a score based on its beta coefficient and the PCDR was developed. ROC curves were derived to test the performance of the PCDR.
  
  
  RESULTS
  Characteristics of derivation and validation cohorts were comparable. Six risk factors (positive blood stream infection, central venous catheter, direct admission to ICU/NICU, hospitalization for ≥ 7 days, immobilization for > 72 h, and use of birth control pills) formed the final risk prediction model (risk score range, 0.5-9.5). A risk score of 3 or more identified high-risk children at a sensitivity of 70% and specificity of 80% and AUC of 0.852 (95% confidence interval, 0.814-0.890). The application of a risk score to the validation sample showed sensitivity 57% and specificity 88% and an AUC of 0.875 (95% confidence interval, 0.82-0.924).
  
  
  CONCLUSIONS
  Incorporation of the PCDR in routine clinical care can be an attractive strategy to identify high-risk hospitalized children with a predisposition for VTE. The clinical utility of the PCDR needs validation in prospective studies.
authors.affiliation: Ann and Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. asharathkumar@luriechildrens.org
authors.forename: A A
authors.initials: AA
authors.lastname: Sharathkumar
authors.forename: A
authors.initials: A
authors.lastname: Mahajerin
authors.forename: L
authors.initials: L
authors.lastname: Heidt
authors.forename: K
authors.initials: K
authors.lastname: Doerfer
authors.forename: M
authors.initials: M
authors.lastname: Heiny
authors.forename: T
authors.initials: T
authors.lastname: Vik
authors.forename: R
authors.initials: R
authors.lastname: Fallon
authors.forename: A
authors.initials: A
authors.lastname: Rademaker
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D020000:Decision Support Systems, Clinical; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D054556:Venous Thromboembolism / Q000453:epidemiology*