title: The role of clinically significant venous thromboembolism and thromboprophylaxis in pediatric patients with pelvic or femoral fractures.
abstract: BACKGROUND
  In adults, pelvic and femoral fractures have a known association with venous thromboembolic disease and, thus, thromboprophylaxis is the standard of care. However, similar data for children are scarce, and recommendations for pediatric prophylaxis are less clear. Our goals were to: (1) analyze the predisposing risk factors, prevalence, and outcome (including mortality) of clinically significant venous thromboembolism; (2) investigate the use of thromboprophylaxis in pediatric trauma patients and ages at which it was given; and (3) determine the impact that central venous catheters had on the occurrence of venous thromboembolism.
  
  
  METHODS
  We reviewed the records of all pediatric patients with pelvic or femoral fracture admitted to our hospital from 1990 through 2009 for occurrence of venous thromboembolism and related mortality, use and effect of central venous catheters, use of thromboprophylaxis (heparin, warfarin, enoxaparin, or factor-X inhibitors), and patient age at administration. Of the 1782 patients, 948 had electronically searchable medication (and device) records. Ninety-five percent confidence intervals were found for all proportions with sample sizes >100, and an unpaired t test was used to compare the average age at which thromboprophylaxis was given with the average age of the total population.
  
  
  RESULTS
  Of the 1782 patients, there were 3 (0.17%) diagnoses of deep vein thrombosis and no diagnoses of pulmonary embolism; there was no related mortality. Of the medication subset (948 patients) only 83 (8.8%) received some type of thromboprophylaxis. The average age of patients given thromboprophylaxis was 14.65 years (SD, 2.34). No central venous catheter was associated with any of the patients who had a venous thromboembolic event.
  
  
  CONCLUSIONS
  Thromboprophylaxis was used only occasionally at our institution; >91% of patients did not receive such treatment. No morbidity or mortality was reported related to venous thromboembolism in pediatric patients with femur or pelvic fracture for whom thromboprophylaxis was used.
  
  
  METHODS
  Level II, retrospective study.
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Lark J
authors.initials: LJ
authors.lastname: Greenwald
authors.forename: Mary Teresa
authors.initials: MT
authors.lastname: Yost
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.forename: Susan M
authors.initials: SM
authors.lastname: Ziegfeld
authors.forename: Michael C
authors.initials: MC
authors.lastname: Ain
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005264:Femoral Fractures / Q000150:complications*; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D008297:Male; D010384:Pelvic Bones / Q000293:injuries; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants