title: Screening Guidelines for Venous Thromboembolism Risk in Hospitalized Children Have Low Sensitivity for Central Venous Catheter-Associated Thrombosis.
abstract: Local pediatric screening guidelines for venous thromboembolism (VTE) are developed from incomplete pediatric data and extrapolated from adult data in which immobility is a major risk factor. We hypothesized that screening guidelines centered on immobility are inadequate for identifying children at risk of central venous catheter (CVC)-associated VTE.
  
  
  
  This retrospective case-control (4:1) study at an academic, quaternary-level, free-standing children's hospital applied screening guidelines for VTE risk to all cases of VTE from July 2012 to April 2014. Cases and controls were classified as "at risk" or "not at risk" of VTE by guideline criteria. These guidelines assessed VTE risk factors, including CVC, as reported in the pediatric literature.
  
  
  
  VTE prevalence was 0.5 per 100 admissions. Sixty-nine of 114 patients with radiographically confirmed VTE were classified as being "at risk" by the guidelines, with a sensitivity of 61%, specificity of 90.8%, a positive predictive value of 2.4%, and negative predictive value of 99.8%. There was no difference in screening guidelines sensitivity for identifying CVC-associated VTE versus non-CVC-associated VTE. Half of the 45 patients with VTE who were not captured as being "at risk" did not have decreased mobility, the entry point to the algorithm, and 80% of these patients had a CVC.
  
  
  
  Screening guidelines have low sensitivity for identifying hospitalized children at increased risk of both CVC-associated and other VTE events. Decreased mobility is not a requirement for CVC-associated VTE. Risk factors extrapolated from adult data are insufficient for identifying children at risk of VTE.
authors.affiliation: Grand Strand Regional Medical Center, Children's Healthcare Services of South Carolina, Myrtle Beach, South Carolina.
authors.forename: Asfawossen B
authors.initials: AB
authors.lastname: Asfaw
authors.affiliation: Divisions of Hematology and.|Children's Hospital and Health System, Milwaukee, Wisconsin; and.
authors.forename: Rowena C
authors.initials: RC
authors.lastname: Punzalan
authors.affiliation: Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Ke
authors.initials: K
authors.lastname: Yan
authors.affiliation: Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Hoffmann
authors.affiliation: Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; shanson@mcw.edu.
authors.forename: Sheila J
authors.initials: SJ
authors.lastname: Hanson
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data; D005260:Female; D017408:Guidelines as Topic / Q000592:standards; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards; D011237:Predictive Value of Tests; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014481:United States; D056824:Upper Extremity Deep Vein Thrombosis / Q000175:diagnosis / Q000628:therapy