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Risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation

  • Christie M. Atchison (a1), Ernest Amankwah (a2) (a3), Jean Wilhelm (a4), Shilpa Arlikar (a3), Brian R. Branchford (a5), Arabela Stock (a6), Michael Streiff (a7), Clifford Takemoto (a7) (a8), Irmel Ayala (a3) (a8), Allen Everett (a4) (a9), Gary Stapleton (a4), Marshall L. Jacobs (a4) (a10), Jeffrey P. Jacobs (a4) (a10) and Neil A. Goldenberg (a3) (a4) (a7) (a8)...

Abstract

Background

Paediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children’s hospitals.

Objective

The aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.

Methods

We conducted a retrospective, case–control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children’s Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression.

Results

Among 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06–31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13–160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13–47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three factors had a markedly increased post-test probability of having hospital-associated venous thromboembolism.

Conclusion

Major infection, infancy, and central venous catheterisation are independent risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or cardiac catheter-based intervention, which, in combination, define a high-risk group for hospital-associated venous thromboembolism.

Copyright

Corresponding author

Correspondence to: N. A. Goldenberg, MD, PhD, All Children’s Research Institute, Johns Hopkins All Children’s Hospital 601, 5th Avenue S. St. Petersburg, FL 33701, United States of America. E-mail: neil@jhmi.edu

References

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Keywords

Risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation

  • Christie M. Atchison (a1), Ernest Amankwah (a2) (a3), Jean Wilhelm (a4), Shilpa Arlikar (a3), Brian R. Branchford (a5), Arabela Stock (a6), Michael Streiff (a7), Clifford Takemoto (a7) (a8), Irmel Ayala (a3) (a8), Allen Everett (a4) (a9), Gary Stapleton (a4), Marshall L. Jacobs (a4) (a10), Jeffrey P. Jacobs (a4) (a10) and Neil A. Goldenberg (a3) (a4) (a7) (a8)...

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