title: A Clinical Tool for the Prediction of Venous Thromboembolism in Pediatric Trauma Patients.
abstract: OBJECTIVE
  Although rare, the incidence of venous thromboembolism (VTE) in pediatric trauma patients is increasing, and the consequences of VTE in children are significant. Studies have demonstrated increasing VTE risk in older pediatric trauma patients and improved VTE rates with institutional interventions. While national evidence-based guidelines for VTE screening and prevention are in place for adults, none exist for pediatric patients, to our knowledge.
  
  
  OBJECTIVE
  To develop a risk prediction calculator for VTE in children admitted to the hospital after traumatic injury to assist efforts in developing screening and prophylaxis guidelines for this population.
  
  
  METHODS
  Retrospective review of 536,423 pediatric patients 0 to 17 years old using the National Trauma Data Bank from January 1, 2007, to December 31, 2012. Five mixed-effects logistic regression models of varying complexity were fit on a training data set. Model validity was determined by comparison of the area under the receiver operating characteristic curve (AUROC) for the training and validation data sets from the original model fit. A clinical tool to predict the risk of VTE based on individual patient clinical characteristics was developed from the optimal model.
  
  
  METHODS
  Diagnosis of VTE during hospital admission.
  
  
  RESULTS
  Venous thromboembolism was diagnosed in 1141 of 536,423 children (overall rate, 0.2%). The AUROCs in the training data set were high (range, 0.873-0.946) for each model, with minimal AUROC attenuation in the validation data set. A prediction tool was developed from a model that achieved a balance of high performance (AUROCs, 0.945 and 0.932 in the training and validation data sets, respectively; P = .048) and parsimony. Points are assigned to each variable considered (Glasgow Coma Scale score, age, sex, intensive care unit admission, intubation, transfusion of blood products, central venous catheter placement, presence of pelvic or lower extremity fractures, and major surgery), and the points total is converted to a VTE risk score. The predicted risk of VTE ranged from 0.0% to 14.4%.
  
  
  CONCLUSIONS
  We developed a simple clinical tool to predict the risk of developing VTE in pediatric trauma patients. It is based on a model created using a large national database and was internally validated. The clinical tool requires external validation but provides an initial step toward the development of the specific VTE protocols for pediatric trauma patients.
authors.affiliation: Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Connelly
authors.affiliation: Division of Biostatistics, Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland.
authors.forename: Amy
authors.initials: A
authors.lastname: Laird
authors.affiliation: Colon and Rectal Clinic of Houston, Department of Surgery, University of Texas, Houston4currently with the Division of Colon and Rectal Surgery, Department of Surgery, Louisiana State University, New Orleans.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Barton
authors.affiliation: Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Fischer
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Krishnaswami
authors.affiliation: Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
authors.affiliation: Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland.
authors.forename: David H
authors.initials: DH
authors.lastname: Zonies
authors.affiliation: Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Watters
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001803:Blood Transfusion; D002405:Catheterization, Central Venous; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D016015:Logistic Models; D035002:Lower Extremity / Q000293:injuries; D008297:Male; D010343:Patient Admission; D010372:Pediatrics; D010384:Pelvic Bones / Q000293:injuries; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012737:Sex Factors; D013514:Surgical Procedures, Operative; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D014947:Wounds and Injuries / Q000150:complications*