Screening and Prophylaxis for Venous Thromboembolism in Pediatric Surgery: A Systematic Review.
Document Type
Article
Publication Date
10-2024
Identifier
DOI: 10.1016/j.jpedsurg.2024.05.015
Abstract
OBJECTIVE: The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee conducted a systematic review to describe the epidemiology of venous thromboembolism (VTE) in pediatric surgical and trauma patients and develop recommendations for screening and prophylaxis.
METHODS: The Medline (Ovid), Embase, Cochrane, and Web of Science databases were queried from January 2000 through December 2021. Search terms addressed the following topics: incidence, ultrasound screening, and mechanical and pharmacologic prophylaxis. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Consensus recommendations were derived based on the best available literature.
RESULTS: One hundred twenty-four studies were included. The incidence of VTE in pediatric surgical populations is 0.29% (Range = 0.1%-0.48%) and directly correlates with surgery type, transfusion, prolonged anesthesia, malignancy, congenital heart disease, inflammatory bowel disease, infection, and female sex. The incidence of VTE in pediatric trauma populations is 0.25% (Range = 0.1%-0.8%) and directly correlates with injury severity, major surgery, central line placement, body mass index, spinal cord injury, and length-of-stay. Routine ultrasound screening for VTE is not recommended. Consider sequential compression devices in at-risk nonmobile, pediatric surgical patients when an appropriate sized device is available. Consider mechanical prophylaxis alone or with pharmacologic prophylaxis in adolescents >15 y and post-pubertal children25. When utilizing pharmacologic prophylaxis, low molecular weight heparin is superior to unfractionated heparin.
CONCLUSIONS: While VTE remains an infrequent complication in children, consideration of mechanical and pharmacologic prophylaxis is appropriate in certain populations.
TYPE OF STUDY: Systematic Review of level 2-4 studies.
LEVEL OF EVIDENCE: Level 3-4.
Journal Title
Journal of pediatric surgery
Volume
59
Issue
10
First Page
161585
Last Page
161585
MeSH Keywords
Humans; Venous Thromboembolism; Child; Postoperative Complications; Incidence; Anticoagulants; Surgical Procedures, Operative; Risk Factors; Adolescent
Keywords
Deep vein thrombosis; Pediatric; Surgery; Venous thromboembolism
Recommended Citation
Kelley-Quon LI, Acker SN, St Peter S, et al. Screening and Prophylaxis for Venous Thromboembolism in Pediatric Surgery: A Systematic Review. J Pediatr Surg. 2024;59(10):161585. doi:10.1016/j.jpedsurg.2024.05.015
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