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2015 ; 100
(8
): 1045-50
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Hospital-associated venous thromboembolism in pediatrics: a systematic review and
meta-analysis of risk factors and risk-assessment models
#MMPMID26001789
Mahajerin A
; Branchford BR
; Amankwah EK
; Raffini L
; Chalmers E
; van Ommen CH
; Goldenberg NA
Haematologica
2015[Aug]; 100
(8
): 1045-50
PMID26001789
show ga
Hospital-associated venous thromboembolism, including deep vein thrombosis and
pulmonary embolism, is increasing in pediatric centers. The objective of this
work was to systematically review literature on pediatric hospital-acquired
venous thromboembolism risk factors and risk-assessment models, to inform future
prevention research. We conducted a literature search on pediatric venous
thromboembolism risk via PubMed (1946-2014) and Embase (1980-2014). Data on risk
factors and risk-assessment models were extracted from case-control studies,
while prevalence data on clinical characteristics were obtained from registries,
large (n>40) retrospective case series, and cohort studies. Meta-analyses were
conducted for risk factors or clinical characteristics reported in at least three
studies. Heterogeneity among studies was assessed with the Cochran Q test and
quantified by the I(2) statistic. From 394 initial articles, 60 met the final
inclusion criteria (20 case-control studies and 40 registries/large case
series/cohort studies). Significant risk factors among case-control studies were:
intensive care unit stay (OR: 2.14, 95% CI: 1.97-2.32); central venous catheter
(OR: 2.12, 95% CI: 2.00-2.25); mechanical ventilation (OR: 1.56, 95%CI:
1.42-1.72); and length of stay in hospital (per each additional day, OR: 1.03,
95% CI: 1.03-1.03). Three studies developed/applied risk-assessment models from a
combination of these risk factors. Fourteen significant clinical characteristics
were identified through non-case-control studies. This meta-analysis confirms
central venous catheter, intensive care unit stay, mechanical ventilation, and
length of stay as risk factors. A few pediatric hospital-acquired venous
thromboembolism risk scores have emerged employing these factors. Prospective
validation is necessary to inform risk-stratified prevention trials.