title: Development of a pediatric-specific clinical probability tool for diagnosis of venous thromboembolism: a feasibility study.
abstract: BACKGROUND
  Pediatric venous thromboembolism (VTE) is an increasingly common, difficult to diagnose problem. Clinical probability tools (CPT) for adults estimate VTE likelihood, but are not available for children. We hypothesized that a pediatric-specific CPT is feasible.
  
  
  METHODS
  Radiology reports were utilized to identify children imaged for suspected VTE. Relevant signs, symptoms, and comorbidity variables, identified from published literature, were extracted from corresponding medical records. Variables associated with pediatric VTE were incorporated into a multivariate logistic regression to create a pilot CPT which was confirmed on a separate cohort.
  
  
  RESULTS
  A total of 389 subjects meeting inclusion criteria were identified: 91 with VTE and 298 without. Univariate analysis revealed male gender (odds ratio (OR) = 2.96; P < 0.001), asymmetric extremity (OR = 1.76; P = 0.033), central venous catheter utilization and/or dysfunction (OR = 2.51; P < 0.001), and cancer (OR = 2.35; P = 0.014) as VTE predictive variables. Documentation of an alternate diagnosis was inversely related to VTE (OR = 0.42; P = 0.004). Receiver operating characteristic analysis of the derived CPT demonstrated reasonable ability to discriminate VTE probability in the training cohort (area under the curve (AUC) = 0.73; P < 0.001) and moderate discrimination in a separate validation cohort of 149 children (AUC = 0.64; P = 0.011).
  
  
  CONCLUSIONS
  A pediatric-specific VTE CPT is feasible, would facilitate early diagnosis, and could lead to improved outcomes.
authors.affiliation: 1] Center for Clinical and Translational Research, The Research Institute at Nationwide Children's, Columbus, Ohio [2] Division of Hem/Onc/BMT, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Kerlin
authors.affiliation: Center for Biostatistics, The Ohio State University, Columbus, Ohio.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Stephens
authors.affiliation: Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Hogan
authors.affiliation: 1] Center for Clinical and Translational Research, The Research Institute at Nationwide Children's, Columbus, Ohio [2] Division of Nephrology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: William E
authors.initials: WE
authors.lastname: Smoyer
authors.affiliation: 1] Division of Hem/Onc/BMT, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio [2] Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's, Columbus, Ohio.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: O'Brien
mesh_terms: D019540:Area Under Curve; D002404:Catheterization; D002648:Child; D003935:Diagnostic Techniques, Cardiovascular; D005121:Extremities / Q000033:anatomy & histology; D005240:Feasibility Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D011859:Radiography; D012737:Sex Factors; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000000981:diagnostic imaging*