title: Venous thromboembolism in hospitalized adolescents: an approach to risk assessment and prophylaxis.
abstract: BACKGROUND
  Pediatric hospital-acquired venous thromboembolism (VTE) is an increasingly prevalent and morbid disease. A multidisciplinary team at a tertiary children's hospital sought to answer the following clinical question: "Among hospitalized adolescents, does risk assessment and stratified VTE prophylaxis compared with no prophylaxis reduce VTE occurrence without an increase in significant adverse effects?"
  
  
  METHODS
  Serial literature searches using key terms were performed in the following databases: Medline, Cochrane Database, CINAHL (Cumulative Index to Nursing and Allied Health), Scopus, EBMR (Evidence Based Medicine Reviews). Pediatric studies were sought preferentially; when pediatric evidence was sparse, adult studies were included. Abstracts and titles were screened, and relevant full articles were reviewed. Studies were rated for quality using a standard rating system.
  
  
  RESULTS
  Moderate evidence exists to support VTE risk assessment in adolescents. This evidence comes from pediatric studies that are primarily retrospective in design. The results of the studies are consistent and cite prominent factors such as immobilization and central venous access. There is insufficient evidence to support specific prophylactic strategies in pediatric patients because available pediatric evidence for thromboprophylaxis efficacy and safety is minimal. There is, however, high-quality, consistent evidence demonstrating efficacy and safety of thromboprophylaxis in adults.
  
  
  CONCLUSIONS
  On the basis of the best available evidence, we propose a strategy for risk assessment and stratified VTE prophylaxis for hospitalized adolescents. This strategy involves assessing risk factors and considering prophylactic measures based on level of risk. We believe this strategy may reduce risk of VTE and appropriately balances the adverse effect profile of mechanical and pharmacologic prophylactic methods.
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: Katie A
authors.initials: KA
authors.lastname: Meier
authors.affiliation: James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: Eloise
authors.initials: E
authors.lastname: Clark
authors.affiliation: Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
authors.forename: Cristina
authors.initials: C
authors.lastname: Tarango
authors.affiliation: Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Ranjit S
authors.initials: RS
authors.lastname: Chima
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; erin.shaughnessy@cchmc.org.
authors.forename: Erin
authors.initials: E
authors.lastname: Shaughnessy
mesh_terms: D000293:Adolescent; D000298:Adolescent, Hospitalized; D000925:Anticoagulants / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods / Q000592:standards; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D000925:Anticoagulants
keywords: health care; pediatrics; prevention and control; pulmonary embolism; quality assurance; risk assessment; venous thromboembolism; venous thrombosis