Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-24T02:49:27.308Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  08 November 2017

Christie M. Atchison ,
Ernest Amankwah ,
Jean Wilhelm ,
Shilpa Arlikar ,
Brian R. Branchford ,
Arabela Stock ,
Michael Streiff ,
Clifford Takemoto ,
Irmel Ayala  and
Allen Everett
...Show all authors
Christie M. Atchison
Affiliation:
Undergraduate Medical Education, Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, United States of America
Ernest Amankwah
Affiliation:
Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Cancer Center, Baltimore, Maryland, United States of America Johns Hopkins All Children’s Cancer and Blood Disorders Institute, St. Petersburg, Florida, United States of America
Jean Wilhelm
Affiliation:
Johns Hopkins All Children’s Heart Institute, St. Petersburg, Florida, United States of America
Shilpa Arlikar
Affiliation:
Johns Hopkins All Children’s Cancer and Blood Disorders Institute, St. Petersburg, Florida, United States of America
Brian R. Branchford
Affiliation:
Section of Hematology/Oncology/Bone Marrow Transplantation, Department of Pediatrics, University of Colorado School of Medicine Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado, United States of America
Arabela Stock
Affiliation:
Division of Critical Care Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
Michael Streiff
Affiliation:
Divisions of Hematology, Departments of Pediatrics and/or Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Clifford Takemoto
Affiliation:
Divisions of Hematology, Departments of Pediatrics and/or Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America Johns Hopkins Medicine Pediatric Thrombosis Program, Johns Hopkins All Children’s Hospital and Johns Hopkins Children’s Center, St. Petersburg, Florida, United States of America
Irmel Ayala
Affiliation:
Johns Hopkins All Children’s Cancer and Blood Disorders Institute, St. Petersburg, Florida, United States of America Johns Hopkins Medicine Pediatric Thrombosis Program, Johns Hopkins All Children’s Hospital and Johns Hopkins Children’s Center, St. Petersburg, Florida, United States of America
Allen Everett
Affiliation:
Johns Hopkins All Children’s Heart Institute, St. Petersburg, Florida, United States of America Division of Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Gary Stapleton
Affiliation:
Johns Hopkins All Children’s Heart Institute, St. Petersburg, Florida, United States of America
Marshall L. Jacobs
Affiliation:
Johns Hopkins All Children’s Heart Institute, St. Petersburg, Florida, United States of America Department of Surgery, Division of Cardiothoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Jeffrey P. Jacobs
Affiliation:
Johns Hopkins All Children’s Heart Institute, St. Petersburg, Florida, United States of America Department of Surgery, Division of Cardiothoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Neil A. Goldenberg*
Affiliation:
Johns Hopkins All Children’s Cancer and Blood Disorders Institute, St. Petersburg, Florida, United States of America Johns Hopkins All Children’s Heart Institute, St. Petersburg, Florida, United States of America Divisions of Hematology, Departments of Pediatrics and/or Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America Johns Hopkins Medicine Pediatric Thrombosis Program, Johns Hopkins All Children’s Hospital and Johns Hopkins Children’s Center, St. Petersburg, Florida, United States of America
*
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: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Venous thromboembolismriskpreventioncardiothoracic surgerycritical illnesscardiac catheterisation
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 2 , February 2018 , pp. 234 - 242
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Raffini, L, Huang, YS, Witmer, C, Feudtner, C. Dramatic increase in venous thromboembolism in children’s hospitals in the United States from 2001 to 2007. Pediatrics 2009; 124: 1001–1008.Google Scholar
2. Gruenwald, CE, Manlhiot, C, Crawford-Lean, L, et al. Management and monitoring of anticoagulation for children undergoing cardiopulmonary bypass in cardiac surgery. J Extra Corpor Technol 2010; 42: 9–19.Google Scholar
3. Monagle, P, Barnes, C, Ignjatovic, V, et al. Developmental haemostasis: impact for clinical haemostasis laboratories. Thromb Haemost. 2006; 95: 362–372.Google Scholar
4. Manlhiot, C, Menjak, IB, Brandão, LR, et al. Risk, clinical features, and outcomes of thrombosis associated with pediatric cardiac surgery. Circulation. 2011; 124: 1511–1519.Google Scholar
5. Chalmers, E, Ganesen, V, Liesner, R, et al. Guideline on the investigation, management and prevention of venous thrombosis in children. Br J Haematol 2011; 154: 196–207.CrossRefGoogle ScholarPubMed
6. Monagle, P, Chan, AK, Goldenberg, NA, et al. Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141 (Suppl 2): e737S–e801S.Google Scholar
7. Pollack, MM, Patel, KM, Ruttimann, JE. PRISM III: an updated pediatric risk of mortality score. Crit Care Med 1996; 24: 743–752.CrossRefGoogle ScholarPubMed
8. Jacobs, JP, Jacobs, ML, Maruszewski, B, et al. Initial application in the EACTS and STS congenital heart surgery databases of an empirically derived methodology of complexity adjustment to evaluate surgical case mix and results. Eur J Cardiothorac Surg 2012; 42: 775–780.Google Scholar
9. Atchison, C, Arlikar, S, Amankwah, E, et al. Development of a new risk score for hospital-associated venous thromboembolism in noncritically ill children: findings from a large single-institutional case-control study. J Pediatr. 2014; 164: 793–798.Google Scholar
10. Arlikar, S, Atchison, CM, Amankwah, EK, et al. Development of a new risk score for hospital-associated venous thromboembolism in critically-ill children not undergoing cardiothoracic surgery. Thromb Res. 2015; 136: 717–722.Google Scholar
11. Amankwah, EK, Atchison, CM, Arlikar, S, et al. Risk factors for hospital-associated venous thromboembolism in the neonatal intensive care unit. Thromb Res. 2014; 134: 305–309.Google Scholar
12. Branchford, BR, Mourani, P, Bajaj, L, Manco-Johnson, M, Wang, M, Goldenberg, NA. Risk factors for in-hospital venous thromboembolism in children: a case control study employing diagnostic validation. Haematologica. 2012; 97: 509–515.Google Scholar
13. Mahajerin, A, Branchford, BR, Amankwah, EK, et al. Hospital-associated venous thromboembolism in pediatrics: a systematic review and meta-analysis of risk factors and risk-assessment models. Haematologica. 2016; 100: 1045–1050.Google Scholar
14. Goldenberg, NA, Knapp-Clevenger, R, Manco-Johnson, MJ, Mountain States Regional Thrombophilia Group. Elevated plasma factor VIII and D-dimer levels as predictors of poor outcomes of thrombosis in children. N Engl J Med 2004; 351: 1081–1088.Google Scholar
15. Monagle, P, Adams, M, Mahoney, M, et al. Outcome of pediatric thromboembolic disease: a report from the Canadian Childhood Thrombophilia Registry. Pediatr Res. 2000; 47: 763–766.Google Scholar
16. Sharathkumar, A, Goldenberg, NA, Chan, A. Epidemiology, etiology, and pathophysiology of infection-associated venous thromboembolism in children. In: Goldenberg NA, Manco-Johnson MJ, (eds) Pediatric Thrombosis Disorders. Cambridge University Press, London, 2015: 88–101.Google Scholar
17. Lyle, C, Goldenberg, NA. Venous thromboembolism. In: da Cruz E, Ivy DD, Jaggers J, Hraska V (eds). Pediatric and Congenital Cardiology, Cardiac Surgery and Cardiac Intensive Care. Springer-Verlag, London, 2014: 3235–3255.Google Scholar