Incidence of venous thromboembolism in pediatric orthopedics: A systematic review - 22/02/24

Doi : 10.1016/j.otsr.2024.103830

Mathieu Boulet ^a, Tristan Langlais ^b, Stéphane Pelet ^a, Étienne Belzile ^a, Caroline Forsythe ^a,⁎
^a Department of Surgery, Division of Orthopaedic Surgery, CHU de Québec, Université Laval, Québec, QC, Canada
^b Orthopaedic Paediatric Department, Children Hospital, CHU Purpan, Toulouse Universitary, Toulouse, France

^⁎Corresponding author. Pediatric Orthopedic Surgery, CHU de Québec, Université Laval, 2600, boulevard Laurier, G1V 4T3, Québec, QC, Canada.Pediatric Orthopedic Surgery, CHU de Québec, Université Laval2600, boulevard Laurier, G1V 4T3, QuébecQCCanada

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 22 February 2024

Abstract

Backgrounds

Children undergoing orthopedic procedures often present numerous risk factors for thromboembolism. A recent survey, conducted by the Pediatric Orthopaedic Society of North America (POSNA), indicates that pediatric orthopedic surgeons are unaware of venous thromboembolism (VTE) prevention protocols and feel that certain procedures should require thromboprophylaxis. The aim of this systematic review was to properly assess the incidence of VTE in pediatric orthopedics. By using a thorough and broad search of the literature, the incidence according to different subspecialties of pediatric orthopedics was evaluated.

Methods

A systematic review on VTE in pediatric orthopedics was conducted. Four databases were searched for articles reporting these events. Three major search concepts: “pediatrics”, “orthopedic surgery/trauma” and “VTE complications” were used and broken down in MeSH, EmTree and their free vocabulary synonyms for proper literature review. Two independent authors screened 8467 titles and abstracts. Seventy articles reporting VTE in children treated by orthopedic surgeons were selected for data extraction. We reported median incidences by orthopedic subtypes and by study characteristics with a semi-quantitative review model.

Results

The 70 articles yielded a total of 845,010 participants. Spine articles (33/70) provided 25,2% of the children included in the review. Trauma studies (16/70) accounted for 47.5% of the participants. The overall VTE median incidence was 0.16% [95% CI: 0.0–1.01%]. Musculoskeletal infections had a noticeably higher median incidence of 3.5% [CI: 0.0–13.8%]. Small variations were seen for the other subtypes: trauma, spine and elective surgeries. Subgroups by article characteristics did not differ significantly either.

Conclusion

Thrombotic complications are rare events in pediatric orthopedics, but knowledge epidemiologic is important because its potential severity. In this review, VTE median incidence for all orthopedic subtypes was around 0.16% [CI: 0.0–1.01%]. According to subspecialty assessment, musculoskeletal infections were associated with greater risk of VTE occurrence.