title: Development of a new risk score for hospital-associated venous thromboembolism in noncritically ill children: findings from a large single-institutional case-control study.
abstract: OBJECTIVE
  To determine risk factors for pediatric hospital-associated venous thromboembolism (HA-VTE) in noncritically ill children to derive a novel HA-VTE risk model for this population.
  
  
  METHODS
  Patients with HA-VTE were identified retrospectively via the electronic health record at All Children's Hospital Johns Hopkins Medicine from April 10, 2013 through January 1, 2006. Seven contemporaneous, noncritically ill control children were randomly selected for each case of HA-VTE. The association between putative risk factors and HA-VTE was estimated with ORs and 95% CIs, which were calculated using the Wald method. A P-value threshold ≤.2 was used in univariate analysis for inclusion into a multivariate (adjusted) model.
  
  
  RESULTS
  Fifty cases of HA-VTE occurred in noncritically ill children. The presence of a central venous catheter (OR 27.67, 95% CI, 8.40-91.22), infection (OR 10.40, 95% CI, 3.46-31.25), and length of stay ≥4 days (OR 5.26, 95% CI, 1.74-15.88) were found to be statistically significant risk factors for HA-VTE. An 8-point risk score was derived in which scores of 8 points, 7 points, and ≤6 points corresponded to venous thromboembolism risks of 12.5%, 1.1%, and 0.1%, respectively.
  
  
  CONCLUSIONS
  The presence of a central venous catheter, infection, and length of stay ≥4 days are significant risk factors for HA-VTE in noncritically ill children, forming the basis for a new risk score that could inform venous thromboembolism prophylaxis decision-making. These findings warrant prospective validation.
authors: Office of Graduate Medical Education, University of South Florida Morsani College of Medicine, Tampa, FL.
authors: Christie M
authors: CM
authors: Atchison
authors: Clinical and Translational Research Organization, All Children's Research Institute, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL.
authors: Shilpa
authors: S
authors: Arlikar
authors: Clinical and Translational Research Organization, All Children's Research Institute, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL.
authors: Ernest
authors: E
authors: Amankwah
authors: Johns Hopkins Medicine Pediatric Thrombosis Program, All Children's Hospital and Johns Hopkins Children's Center, St. Petersburg, FL and Baltimore, MD.
authors: Irmel
authors: I
authors: Ayala
authors: Clinical and Translational Research Organization, All Children's Research Institute, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL; Johns Hopkins Medicine Pediatric Thrombosis Program, All Children's Hospital and Johns Hopkins Children's Center, St. Petersburg, FL and Baltimore, MD.
authors: Laurie
authors: L
authors: Barrett
authors: Department of Pediatrics, Section of Hematology/Oncology/Bone Marrow Transplantation, University of Colorado School of Medicine Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO.
authors: Brian R
authors: BR
authors: Branchford
authors: Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Michael
authors: M
authors: Streiff
authors: Johns Hopkins Medicine Pediatric Thrombosis Program, All Children's Hospital and Johns Hopkins Children's Center, St. Petersburg, FL and Baltimore, MD; Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Clifford
authors: C
authors: Takemoto
authors: Clinical and Translational Research Organization, All Children's Research Institute, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL; Johns Hopkins Medicine Pediatric Thrombosis Program, All Children's Hospital and Johns Hopkins Children's Center, St. Petersburg, FL and Baltimore, MD; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: neil@jhmi.edu.
authors: Neil A
authors: NA
authors: Goldenberg
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult