Identification of a "VTE-rich" population in pediatrics - Critically ill children with central venous catheters.
Tran Minh,Shein Steven L,Ji Xinge,Ahuja Sanjay P
BACKGROUND:The incidence of venous thromboembolism (VTE) is rising among inpatients in US hospitals, especially among kids with central venous catheters (CVCs) in the pediatric intensive care unit (PICU). OBJECTIVES:To identify a sub-group of "VTE-rich" population among PICU children, and to assess the effect of VTE on morbidity and mortality. METHODS:Data was extracted from a multicenter Virtual PICU Database, or VPS, for children with a CVC and presence of a VTE. The primary outcome variable was all cause mortality and secondary outcome measure was prolonged mechanical ventilation. Primary diagnoses and Pediatric risk of mortality 2 (PIM 2) score were also recorded. RESULTS:The database identified 158,299 PICU patients who had a CVC. A total of 1602 patients had VTE (103 per 10,000 PICU patients). Multivariate analysis showed increased risk of VTE in patients who were <1year old (OR 1.48; 1.30-1.68), mechanically ventilated (OR 2.48; 2.07-2.98), had either a diagnostic (OR 2.32; 1.94-2.78) or therapeutic cardiac catheterization (OR 2.06; 1.66-2.55), PICC (OR 3.91; 3.50-4.37), and percutaneous CVC (OR 3.99; 3.48-4.61). Primary diagnoses associated with VTE were endocrinologic, immunologic, and gastrointestinal disorders. PICU patients with CVC and VTE had increased odds of mortality (OR 1.71; 1.47-2.00) after adjusting for factors associated with mortality, and fewer Ventilator Free Days (VFD) than patients without VTE. CONCLUSIONS:Critically ill children with CVC have a significant risk of developing VTE. Identification of the above "VTE-rich" population may aid in design of clinical trials aimed at prevention of VTE among hospitalized PICU children.