Epidemiology of Lower Extremity Deep Venous Thrombosis in Critically Ill Adolescents - 21/09/18
, Veronika Shabanova, PhD 1, Matthew G. Pinto, MD 2, Simon Li, MD, MPH 2, Erin Trakas, MD 3, Michael Miksa, MD, PhD 4, Shira Gertz, MD 5, Lee A. Polikoff, MD 6, Massimo Napolitano, MD 7, Adele R. Brudnicki, MD 8, Joana A. Tala, MD 9, Cicero T. Silva, MD 10for the
THrombosis Epidemiology in Ill Adolescents (THEIA) Study Investigators*
Abstract |
Objective |
To determine the epidemiology of lower extremity deep venous thrombosis (DVT) in critically ill adolescents, which currently is unclear.
Study design |
We performed a multicenter, prospective, cohort study. Adolescents aged 13-17 years who were admitted to 6 pediatric intensive care units and were anticipated to receive cardiopulmonary support for at least 48 hours were eligible, unless they were admitted with DVT or pulmonary embolism or were receiving or anticipated to receive therapeutic anticoagulation. While patients were in the unit, serial sonograms of the lower extremities were performed, then centrally adjudicated. Bayesian statistics were used to leverage the similarities between adults and adolescents.
Results |
A total of 88 adolescents were enrolled, from whom 184 lower extremity sonograms were performed. Of these, 9 adolescents developed DVT, with 1 having bilateral DVT. The frequency of DVT was 12.4% (95% credible interval: 6.1%, 20.1%), which ranged from 6.3% to 19.8% with a variability of 41.0% across units. All cases of DVT occurred in adolescents who received invasive mechanical ventilation (frequency: 16.5%; 95% credible interval 8.1%, 26.6%). DVT was associated with femoral central venous catheterization (OR 15.44; 95% credible interval 1.62, 69.05) and severe illness (OR for every 0.1 increase in risk of mortality 3.11; 95% credible interval 1.19, 6.85). DVT appears to be associated with prolonged days on support.
Conclusions |
Our findings highlight the similarities and differences in the epidemiology of DVT between adults and adolescents. They support the conduct and inform the design of a trial of pharmacologic prophylaxis in critically ill adolescents.
Le texte complet de cet article est disponible en PDF.Keywords : Bayesian statistics, intensive care unit, pediatrics, pulmonary embolism, venous thromboembolism
Abbreviations : CrI, CVC, DVT, ICU, PE, PIM2, RCT, THEIA
Plan
| Supported in part by the American Heart Association Award Number 14CRP20490002 (to E.F.). It also was made possible by Clinical and Translational Science Award (CTSA) Grant Number UL1 RR024139 from the National Center for Research Resources (NCRR) and the National Center for Advancing Translational Science (NCATS), components of the National Institutes of Health (NIH), and NIH roadmap for Medical Research (to V.S.), and an unrestricted grant support from Layla's Dream (to L.P.)The other authors declare no conflicts of interest. |
Vol 201
P. 176 - octobre 2018 Retour au numéro
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