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Venous thromboembolism in acutely ill children
  1. E F Brooker1,
  2. M S Shannon2
  1. 1Paediatrics, St. George's Hospital, London, UK
  2. 2Haematology, St. George's Hospital, London, UK

Abstract

Aims To identify the incidence of confirmed venous thromboembolism (VTE) in a paediatric intensive care unit (PICU) population.

Introduction The National Institute for Clinical Excellence (NICE) requires that all hospitalised patients over 18 are assessed for risk of VTE and given appropriate prophylaxis.1 Childhood VTE has a reported annual incidence of 0.5–0.7:100 000 increasing 100-fold in a hospitalised population 2. There is scanty data on VTE risk factors in hospitalised children and little evidence based guidance on prevention and treatment. This study looked at admissions to a PICU to identify the incidence of confirmed VTE and associated risk factors.

Method Discharge summaries of all children admitted to PICU over a 1 year period were screened to identify those with any reference to venous thrombosis or anticoagulation. The notes were examined and those with objective confirmation of venous thrombosis were included.

Results There were 528 admissions (446 children). VTE was confirmed in seven (1.3%) children, of these six (1.1%) were acute and one was diagnosed prior to PICU admission. Three children were aged between 1 and 10 years and one was a premature infant. There were four femoral DVT and two sagittal sinus thromboses (SST). All cases had an intercurrent infection; all femoral DVT had a central venous catheter (CVC) in situ, SST was diagnosed in association with other illnesses – one acute myeloid leukaemia and one subdural empyema.

Conclusion While the numbers in this study are small, 6 acute VTE in 528 admissions, the incidence is 20 times that quoted in the literature with the majority in the age group reported as having the lowest incidence.2 All children had at least one well established ‘adult’ VTE risk factor – severe infection, CVCs and malignancy with all but one having multiple risk factors. The study supports the need to assess acutely ill children for VTE risk, to implement VTE prophylaxis in at risk children and for undertaking confirmatory investigations when the diagnosis of VTE is suspected.

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