title: Hospital-associated venous thromboembolism in pediatrics: a systematic review and meta-analysis of risk factors and risk-assessment models.
abstract: Hospital-associated venous thromboembolism, including deep vein thrombosis and pulmonary embolism, is increasing in pediatric centers. The objective of this work was to systematically review literature on pediatric hospital-acquired venous thromboembolism risk factors and risk-assessment models, to inform future prevention research. We conducted a literature search on pediatric venous thromboembolism risk via PubMed (1946-2014) and Embase (1980-2014). Data on risk factors and risk-assessment models were extracted from case-control studies, while prevalence data on clinical characteristics were obtained from registries, large (n>40) retrospective case series, and cohort studies. Meta-analyses were conducted for risk factors or clinical characteristics reported in at least three studies. Heterogeneity among studies was assessed with the Cochran Q test and quantified by the I(2) statistic. From 394 initial articles, 60 met the final inclusion criteria (20 case-control studies and 40 registries/large case series/cohort studies). Significant risk factors among case-control studies were: intensive care unit stay (OR: 2.14, 95% CI: 1.97-2.32); central venous catheter (OR: 2.12, 95% CI: 2.00-2.25); mechanical ventilation (OR: 1.56, 95%CI: 1.42-1.72); and length of stay in hospital (per each additional day, OR: 1.03, 95% CI: 1.03-1.03). Three studies developed/applied risk-assessment models from a combination of these risk factors. Fourteen significant clinical characteristics were identified through non-case-control studies. This meta-analysis confirms central venous catheter, intensive care unit stay, mechanical ventilation, and length of stay as risk factors. A few pediatric hospital-acquired venous thromboembolism risk scores have emerged employing these factors. Prospective validation is necessary to inform risk-stratified prevention trials.
authors.affiliation: CHOC Children's Specialists, Division of Hematology, Orange, CA, USA amahajerin@choc.org.
authors.forename: Arash
authors.initials: A
authors.lastname: Mahajerin
authors.affiliation: Department of Pediatrics, Section of Hematology/Oncology/Bone Marrow Transplantation and the University of Colorado Hemophilia and Thrombosis Center, University of Colorado Denver and Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Branchford
authors.affiliation: Clinical and Translational Research Organization, All Children's Research Institute, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL, USA.
authors.forename: Ernest K
authors.initials: EK
authors.lastname: Amankwah
authors.affiliation: Department of Pediatrics, Division of Hematology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Raffini
authors.affiliation: Department of Haematology, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chalmers
authors.affiliation: Department of Pediatric Haematology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: C Heleen
authors.initials: CH
authors.lastname: van Ommen
authors.affiliation: Divisions of Hematology, Departments of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA All Children's Hospital Johns Hopkins Medicine and All Children's Research Institute, St. Petersburg, FL, USA.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Goldenberg
mesh_terms: D016022:Case-Control Studies; D002648:Child; D017052:Hospital Mortality; D006801:Humans; D007049:Iatrogenic Disease; D015994:Incidence; D016017:Odds Ratio; D010372:Pediatrics; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology*