Aims Prevalence of paediatric venous thromboembolism (VTE) is estimated at 5.3 per 10,000 hospital admissions.
There is a bimodal distribution of incidences with peaks in the neonatal period and in adolescence. 90% of events are related to underlying risk factors, of which, central venous lines are the most important but surgery and trauma are also included. Adolescent VTE comprises 40% of all paediatric VTE event; they tend to be in the lower-limb and symptomatic. VTE is extremely rare from 1 month of age until the onset of puberty.
A number of tertiary children’s hospitals have implemented and published guidelines for structured risk assessment and prophylaxis of VTE in children. We aimed to assess whether routine assessment of all surgical admissions for VTE risk would benefit patient care.
Methods All admissions (elective and emergency) to orthopaedic and general surgery paediatric wards at a tertiary children’s hospital over 31 days were included. Neonatal admissions were excluded. All patients underwent a VTE risk assessment. The assessment used a structured pro-forma, based on existing published protocols.
Data was collected on details of any VTE events, risk factors for thrombosis or bleeding, reason for admission and/or operation, and whether any VTE prophylaxis was given.
Results Orthopaedics: 56/80 admissions (median 9 years); no VTE events during study period. 80% (45/56) had no risk factors for VTE. The remainder had on average 1 risk factor for thrombosis (‘Reduced mobility’ or ‘Lower limb orthopaedic surgery’). 2/56 (4%) exceptional cases received pharmacological thromboprophylaxis: both were >15-years old, one with bilateral femoral fractures; the other had a familial thrombophilia.
General surgery: 24/80 admissions (median 7 years); no VTE events occurred. 88% (21/24) had no risk factors for VTE. The remaining 3/24 were considered low risk. No patients were prescribed VTE prophylaxis.
All patients under 15-years (74/80) were ‘low-risk’, whereas 2/6 (33%) patients over 15-years required thromboprophylaxis.
Conclusion We found that routine, structured assessment of VTE risk in children under 15-years is not necessary. There are selected adolescents who may benefit from prophylactic measures, thus VTE risk assessment is recommended in patients >15-years.
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