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Abrahão R, Brunson A, Chubak J, Wernli KJ, Nichols HB, Chao C, Ruddy KJ, Hahn EE, Li Q, Malogolowkin MH, Sauder CAM, Kushi LH, Wun T, Keegan THM. Late venous thromboembolism in survivors of adolescent and young adult cancer: A population-based study in California. Thromb Res 2024; 235:1-7. [PMID: 38244373 PMCID: PMC10989999 DOI: 10.1016/j.thromres.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/24/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Venous thromboembolism (VTE), a common complication in cancer patients, occurs more often during the initial phase of treatment. However, information on VTE beyond the first two years after diagnosis ('late VTE') is scarce, particularly in young survivors. METHODS We examined the risk of, and factors associated with, late VTE among adolescents and young adults (AYA, 15-39 years) diagnosed with cancer (2006-2018) who survived ≥2 years. Data were obtained from the California Cancer Registry linked to hospitalization, emergency department and ambulatory surgery data. We used non-parametric models and Cox proportional hazard regression for analyses. RESULTS Among 59,343 survivors, the 10-year cumulative incidence of VTE was 1.93 % (CI 1.80-2.07). The hazard of VTE was higher among those who had active cancer, including progression from lower stages to metastatic disease (Hazard Ratio (HR) = 10.41, 95 % confidence interval (CI): 8.86-12.22), second primary cancer (HR = 2.58, CI:2.01-3.31), or metastatic disease at diagnosis (HR = 2.38, CI:1.84-3.09). The hazard of late VTE was increased among survivors who underwent hematopoietic cell transplantation, those who received radiotherapy, had a VTE history, public insurance (vs private) or non-Hispanic Black/African American race/ethnicity (vs non-Hispanic White). Patients with leukemias, lymphomas, sarcoma, melanoma, colorectal, breast, and cervical cancers had a higher VTE risk than those with thyroid cancer. CONCLUSIONS VTE risk remained elevated ≥2 years following cancer diagnosis in AYA survivors. Active cancer is a significant risk factor for VTE. Future studies might determine if late VTE should prompt evaluation for recurrence or second malignancy, if not already known.
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Affiliation(s)
- Renata Abrahão
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America.
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America
| | - Hazel B Nichols
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Chun Chao
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Erin E Hahn
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Qian Li
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
| | - Marcio H Malogolowkin
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California Davis School of Medicine, Sacramento, CA, United States of America
| | - Candice A M Sauder
- Division of Surgical Oncology, Department of Surgery, University of California Davis, Sacramento, CA, United States of America; University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
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Athale U, Halton J, Gayowsky A, Chan AKC, Pole JD. Development and validation of thromboembolism diagnostic algorithms in children with cancer from real-world data. Pediatr Res 2024:10.1038/s41390-024-03082-x. [PMID: 38388822 DOI: 10.1038/s41390-024-03082-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/03/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To evaluate the accuracy of diagnostic algorithms developed using the International Classification of Diseases (ICD-9-CM and ICD-10-CA) diagnostic codes and physician billing codes for thromboembolism (TE) from health administrative data compared to chart review diagnoses of TE in children with cancer. METHODS Using data linkage between the Pediatric Oncology Group of Ontario Network Information System (Ontario pediatric cancer registry) and various administrative data housed at ICES, eight algorithms were developed including a single reference to one of the billing codes, multiple references with varying time intervals, and combinations of various billing codes during primary cancer therapy for the whole cohort and, for early (<04/2002) and later (≥04/2002, solely ICD-10 codes) periods. Reference standard was chart review data from prior studies (from 1990 to 2016) among children (≤19 years) with cancer and radiologically confirmed TE. RESULTS Records of 2056 patients diagnosed with cancer at two participating sites during study period were reviewed; 112 had radiologically confirmed TE. The algorithm with addition of anticoagulation utilization codes was the best performing algorithm (sensitivity = 0.76;specificity = 0.85). With use of ICD-10 only codes, sensitivity of the same algorithm improved to 0.84 with specificity of 0.80. CONCLUSION This study provides a valid approach for ascertaining pediatric TE using real-world data. IMPACT Research in pediatric thrombosis, especially cancer-related thrombosis, is limited mainly due to small-sized studies. Real-world data provide ready access to large and diverse populations. However, there are no validated algorithms for identifying thrombosis in real-world data for children. An algorithm based on combination of thrombosis and anticoagulation utilization codes had 76% sensitivity and 85% specificity to identify diagnosis of thrombosis in children in administrative data. This study provides a valid approach for ascertaining pediatric thrombosis using real-world data and offers a good avenue to advance pediatric thrombosis research.
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Affiliation(s)
- Uma Athale
- Division of Hematology/Oncology, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada.
- Pediatrics, McMaster University, Hamilton, Ontario, Canada.
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Jacqueline Halton
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Anthony K C Chan
- Division of Hematology/Oncology, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jason D Pole
- Centre for Health Services Research, The University of Queensland, Queensland, Australia
- ICES, Toronto, Ontario, Canada
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3
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Morrison JM, Betensky M, Kiskaddon AL, Goldenberg NA. Venous Thromboembolism among Noncritically Ill Hospitalized Children: Key Considerations for the Pediatric Hospital Medicine Specialist. Semin Thromb Hemost 2021; 48:434-445. [PMID: 33962474 DOI: 10.1055/s-0041-1729170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Venous thromboembolism (VTE) is a leading cause of morbidity and preventable harm among noncritically ill hospitalized children. Several clinical factors relevant to the noncritically ill hospitalized child significantly increase the risk of VTE including the presence of central venous catheters, systemic inflammation, and prolonged immobilization. Although risk mitigation strategies have been described, the diagnosis, treatment, and prevention of VTE require standardization of institutional practices combined with multidisciplinary collaboration among pediatric hospitalists, hematologists, and other care providers. In this narrative review, we summarize the epidemiology of VTE, risk models identifying high-risk conditions associated with VTE, and prevention and treatment strategies. We further describe successful quality improvement efforts implementing institutional VTE risk stratification and thromboprophylaxis procedures. Finally, we highlight unique challenges facing pediatric hospital medicine specialists in the era of the COVID-19 pandemic, including caring for adults admitted to pediatric hospital units, and describe future research opportunities for VTE in the noncritically ill hospitalized child.
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Affiliation(s)
- John M Morrison
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Marisol Betensky
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Pediatric Hematology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Amy L Kiskaddon
- Department of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Neil A Goldenberg
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Pediatric Hematology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
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4
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Hsiao W, Krava E, Wee CP, Chau E, Jaffray J. The incidence and risk factors for venous thromboembolism in adolescent and young adult oncology patients. Pediatr Blood Cancer 2021; 68:e28957. [PMID: 33624938 DOI: 10.1002/pbc.28957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a known complication among pediatric and adult cancer patients. Adolescent and young adult oncology (AYAO) patients have unique biological and physiological characteristics that make them distinct from other populations. Our objective was to study the VTE incidence, risk factors, and outcomes, which have been understudied in this population. PROCEDURE A retrospective case-control study was conducted on AYAO participants with new or relapsed cancer and an imaging confirmed VTE from January 2011 to November 2016 at our institution. Eligible AYAO participants without a history of VTE were designated as controls and were randomly selected from our institution's tumor registry. Demographics, medical history, surgeries, central venous catheter (CVC) data, VTE diagnosis and treatment, relapses, and deaths were abstracted. RESULTS Thirty-five VTE cases and 70 controls were included in this analysis. Eighty percent of cases had leukemia or lymphoma (vs. a solid tumor) compared to 58% of controls. The majority of VTEs (57%) were CVC associated, and more than 70% of cases had more than one CVC placed during their cancer treatment versus 34% of controls. Infection was associated with increased VTE risk (OR = 6.35, 95% CI = 2.30, 17.55, p < .0001). VTE cases had increased cancer relapse (23% vs. 10%) and mortality rates (29% vs. 16%) than controls. CONCLUSION AYAO participants with a VTE were more likely to have leukemia or lymphoma, more than one CVC or infection. Further studies are needed to identify patients who would benefit from modifiable prevention measures, such as limiting to one CVC, preventing infections, or considering prophylactic anticoagulation for those with a liquid tumor.
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Affiliation(s)
- Wendy Hsiao
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Emily Krava
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Choo Phei Wee
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Edward Chau
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Julie Jaffray
- Children's Hospital Los Angeles, Los Angeles, California, USA.,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Graham RT, Coven SL, Stanek JR, Folta A, Hollingsworth EW, Finlay JL, Kumar R. Venous thromboembolism in children with central nervous system tumors: Comparison of an institutional cohort to a national administrative database. Pediatr Blood Cancer 2021; 68:e28846. [PMID: 33340265 DOI: 10.1002/pbc.28846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Central nervous system (CNS) tumors are the second most common malignancy of childhood, and published data on venous thromboembolism (VTE) rate and risk factors for these patients are outdated or incomplete. Here, we determine the cumulative incidence and risk factors for VTE in this population. PROCEDURE VTE diagnosis and associated clinical risk factors were abstracted and analyzed for two cohorts of children (0-21 years) diagnosed with CNS tumors between January 1, 2010 to September 30, 2018. The first study was a retrospective single institution cohort study. The initial observations were confirmed across multiple pediatric hospitals using the Pediatric Health Information System (PHIS) administrative database. RESULTS The single-institution cohort included 338 patients aged 3 days to 20.9 years (median age, 8.6 years); VTE developed in eight (2.4%) patients. The PHIS cohort included 17 634 patients aged from 0 to 21.9 years (median: 9.5 years); VTE developed in 354 (2.0%) patients. Univariate analysis for the single-institution cohort identified central venous catheter (CVC) placement as a risk factor for VTE (odds ratio [OR] 8.40, 95% confidence interval [CI] 1.43-49.41, P = .0186). Multivariable analysis of the PHIS dataset identified CVC placement (OR 1.97, 95% CI 1.57-2.46; P < .0001), obesity (OR 2.96, 95% CI 1.21-7.26; P = .0177), and more than one hospital admission (OR 3.54, 95% CI 2.69-4.64; P < .0001) as significant predictors of VTE. VTE diagnosis was not associated with increased mortality in either cohort. CONCLUSIONS The VTE rate in children with CNS tumors is low (2%). CVC placement was identified as a modifiable risk factor in both cohorts.
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Affiliation(s)
- Richard T Graham
- Division of Neuro-Oncology, Department of Pediatrics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Scott L Coven
- Department of Pediatrics, Indiana University, Riley Children's Hospital, Indianapolis, Indiana
| | - Joseph R Stanek
- Division of Hematology/Oncology, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio
| | - Ashley Folta
- Division of Hematology/Oncology, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio
| | - Ethan W Hollingsworth
- Medical Scientist Training Program, University of California, Irvine, California
- Department of Anatomy and Neurobiology, University of California, Irvine, California
| | - Jonathan L Finlay
- Division of Hematology/Oncology, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio
| | - Riten Kumar
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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6
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Howie C, Erker C, Crooks B, Moorehead P, Kulkarni K. Incidence and risk factors of venous thrombotic events in pediatric patients with CNS tumors compared with non-CNS cancer: A population-based cohort study. Thromb Res 2021; 200:51-55. [PMID: 33540292 DOI: 10.1016/j.thromres.2021.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a well-recognized complication in pediatric cancer patients. It has been demonstrated that the incidence of VTE in pediatric patients with central nervous system (CNS) tumors is lower than that of patients with other cancers. Risk factors for developing cancer-related thrombosis are numerous and can include patient, disease, or treatment-related influences. The present study was designed to assess the VTE incidence in a pediatric oncology population, and to investigate whether intensity of treatment has similar associated with risk of VTE development in patients with and without CNS tumors. METHODS A retrospective population-based cohort study of pediatric oncology patients in Atlantic Canada was conducted. Data collected from medical records included demographics, cancer type, treatment, presence of central venous catheters (CVC), and presence of thrombosis. Treatment intensity was assessed using the intensity of treatment rating scale (ITR-3). Study period was from January 2000 to December 2017. SPSS version 24 was used for statistical analysis. RESULTS Of 1262 patients with pediatric cancer, 247 (19.6%) had CNS tumors. VTE occurred in significantly fewer (n = 5, 2%) patients with CNS tumors compared with patients with non-CNS cancers (n = 79, 7.8%) (p = 0.001). The ITR-3 scores did not differ significantly between the CNS and non-CNS groups (p = 0.638). In a multivariate logistic regression analysis, ITR-3 score was associated with VTE (odds ratio [OR]: 1.48, 95% CI: 1.2-1.9), while presence of CNS tumor was protective (OR: 0.26, 95% CI: 0.1-0.6). CONCLUSIONS We demonstrate that pediatric patients with CNS tumors experience a significantly lower incidence of VTE compared with patients with non-CNS cancer. An increase in the ITR-3 rating significantly increased the odds of developing VTE.
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Affiliation(s)
- Chelsea Howie
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Craig Erker
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Bruce Crooks
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Paul Moorehead
- Pediatric Hematology/Oncology, Janeway Children's Health and Rehabilitation Centre, St. John's, NL, Canada; Faculty of Medicine, Memorial University, St. John's, NL, Canada; Janeway Pediatric Research Unit, Memorial University, St. John's, NL, Canada
| | - Ketan Kulkarni
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada.
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Moss SR, Jenkins AM, Caldwell AK, Herbst BF, Kelleher ME, Kinnear B, Ambroggio L, Herbst LA, Chima RS, O'Toole JK. Risk Factors for the Development of Hospital-Associated Venous Thromboembolism in Adult Patients Admitted to a Children's Hospital. Hosp Pediatr 2020; 10:166-172. [PMID: 31924691 DOI: 10.1542/hpeds.2019-0052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Hospital-associated venous thromboembolism (HA-VTE) is a leading cause of preventable in-hospital mortality in adults. Our objective was to describe HA-VTE and evaluate risk factors for its development in adults admitted to a children's hospital, which has not been previously studied. We also evaluated the performance of commonly used risk assessment tools for HA-VTE. METHODS A case-control study was performed at a freestanding children's hospital. Cases of HA-VTE in patients ≥18 years old (2013-2017) and age-matched controls were identified. We extracted patient and HA-VTE characteristics and HA-VTE risk factors on the basis of previous literature. Thrombosis risk assessment was performed retrospectively by using established prospective adult tools (Caprini and Padua scores). RESULTS Thirty-nine cases and 78 controls were identified. Upper extremities were the most common site of thrombosis (62%). Comorbid conditions were common (91.5%), and malignancy was more common among case patients than controls (P = .04). The presence of a central venous catheter (P < .01), longer length of stay (P < .01), ICU admission (P = .005), and previous admission within 30 days (P = .01) were more common among case patients when compared with controls. Median Caprini score was higher for case patients (P < .01), whereas median Padua score was similar between groups (P = .08). CONCLUSIONS HA-VTE in adults admitted to children's hospitals is an important consideration in a growing high-risk patient population. HA-VTE characteristics in our study were more similar to published data in pediatrics.
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Affiliation(s)
- Stephanie R Moss
- Divisions of Hospital Medicine and
- Pediatrics, and
- Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Department of Hospital Medicine, Medicine Institute and
- Department of Pediatric Hospital Medicine, Pediatrics Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Ashley M Jenkins
- Divisions of Hospital Medicine and
- Pediatrics, and
- Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Alicia K Caldwell
- Divisions of Hospital Medicine and
- Pediatrics, and
- Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brian F Herbst
- Divisions of Hospital Medicine and
- Pediatrics, and
- Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Matthew E Kelleher
- Divisions of Hospital Medicine and
- Pediatrics, and
- Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Benjamin Kinnear
- Divisions of Hospital Medicine and
- Pediatrics, and
- Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Lilliam Ambroggio
- Divisions of Hospital Medicine and
- Pediatrics, and
- Sections of Emergency Medicine and Hospital Medicine, Department of Pediatrics, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Lori A Herbst
- Divisions of Hospital Medicine and
- Pediatrics, and
- Divisions of Geriatrics and Palliative Care, Departments of Family and Community Medicine
| | - Ranjit S Chima
- Pediatrics, and
- Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer K O'Toole
- Divisions of Hospital Medicine and
- Pediatrics, and
- Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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8
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Gartrell J, Kaste SC, Sandlund JT, Flerlage J, Zhou Y, Cheng C, Estepp J, Metzger ML. The association of mediastinal mass in the formation of thrombi in pediatric patients with non-lymphoblastic lymphomas. Pediatr Blood Cancer 2020; 67:e28057. [PMID: 31736198 PMCID: PMC7233458 DOI: 10.1002/pbc.28057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Children diagnosed with cancer are at a significantly higher risk of developing a thrombotic event (TE) compared with the general population. The rarity of these events makes it difficult to discern the specific risk factors; however, age, sex, presence of central venous lines, inherited thrombophilia, and mediastinal mass may play a role. The primary aim of this study is to identify prognostic characteristics of children diagnosed with non-lymphoblastic lymphomas associated with a greater risk of developing a TE early on in their disease, with an increased focus on mediastinal mass characteristics. METHODS Retrospective chart review of pediatric patients diagnosed with non-lymphoblastic lymphoma between 2004 and 2014 at St. Jude Children's Research Hospital. RESULTS TE occurred in 8.5% (n = 28/330) of individuals at a median of 21 days from the diagnosis of a non-lymphoblastic lymphoma, with 60% of TEs occurring within 30 days of diagnosis. Of the variables evaluated, only presence of a peripherally inserted central catheter (odds ratio [OR]: 3.14 [95% CI: 1.24-7.98; P = 0.02]) and degree of superior vena cava (SVC) compression of > 25% increased the odds of developing a TE (OR: 2.2 [95% CI: 1.01-4.93; P = 0.048]). CONCLUSION Pediatric patients with non-lymphoblastic lymphoma are at increased risk of developing TEs. In contrast to previous studies, the presence of a mediastinal mass alone was not associated with a higher risk of TE, but individuals with a mediastinal mass with 25% or greater degree of SVC compression were more likely to develop a TE. This finding highlights a high-risk group of children who may benefit from prophylactic anticoagulation.
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Affiliation(s)
- Jessica Gartrell
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN,University of Tennessee Health Science Center, Memphis, TN
| | - Sue C. Kaste
- University of Tennessee Health Science Center, Memphis, TN,Department of Diagnostic Imaging, St Jude Children’s Research Hospital, Memphis, TN
| | - John T. Sandlund
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN,University of Tennessee Health Science Center, Memphis, TN
| | - Jamie Flerlage
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN,University of Tennessee Health Science Center, Memphis, TN
| | - Yinmei Zhou
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, TN
| | - Cheng Cheng
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, TN
| | - Jeremie Estepp
- University of Tennessee Health Science Center, Memphis, TN,Department of Hematology, St Jude Children’s Research Hospital, Memphis, TN
| | - Monika L. Metzger
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN,University of Tennessee Health Science Center, Memphis, TN
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10
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Prevalence and risk factors for venous thromboembolism in children with sickle cell disease: an administrative database study. Blood Adv 2019; 2:285-291. [PMID: 29431623 DOI: 10.1182/bloodadvances.2017012336] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/04/2018] [Indexed: 11/20/2022] Open
Abstract
A hypercoagulable state resulting in increased venous thromboembolism (VTE) has been described in adults with sickle cell disease (SCD), but similar data for children are lacking. The objective of this retrospective cohort study was to describe the rate of VTE and risk factors associated with VTE in children with SCD across tertiary-care children's hospitals in the United States between the years 2009 and 2015. We used the Pediatric Health Information System database to investigate all pediatric patients with SCD admitted to 1 of 48 participating institutions between 1 January 2009 and 30 September 2015. International Classification of Disease, Ninth Edition, Clinical Modification codes were used to identify index thromboembolic events and chronic medical conditions known to be associated with VTE. Billing codes were used to identify central venous line (CVL) placement and pharmaceutical billing codes to identify estrogen containing oral-contraceptive use. Logistic regression analysis was used to study the association among unique patient characteristics, VTE, and death. 10 454 eligible subjects with SCD were identified. Median age (±interquartile range) of study cohort was 10 (±11) years. 181 subjects (1.7%) developed an index venous thromboembolic event during the study period. Median age at VTE diagnosis was 15.9 (±7.4) years. On multivariable logistic regression analysis, CVL placement, chronic renal disease, history of stroke, female sex, length of hospitalization, intensive care unit utilization, and older age were associated with VTE. After adjusting for other variables, VTE was independently associated with death. In summary, VTE can occur in pediatric patients with SCD. CVL placement is a modifiable risk factor for VTE development.
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12
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Faustino EVS, Shabanova V, Pinto MG, Li S, Trakas E, Miksa M, Gertz S, Polikoff LA, Napolitano M, Brudnicki AR, Tala JA, Silva CT. Epidemiology of Lower Extremity Deep Venous Thrombosis in Critically Ill Adolescents. J Pediatr 2018; 201:176-183.e2. [PMID: 29891258 DOI: 10.1016/j.jpeds.2018.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/03/2018] [Accepted: 05/03/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the epidemiology of lower extremity deep venous thrombosis (DVT) in critically ill adolescents, which currently is unclear. STUDY DESIGN We performed a multicenter, prospective, cohort study. Adolescents aged 13-17 years who were admitted to 6 pediatric intensive care units and were anticipated to receive cardiopulmonary support for at least 48 hours were eligible, unless they were admitted with DVT or pulmonary embolism or were receiving or anticipated to receive therapeutic anticoagulation. While patients were in the unit, serial sonograms of the lower extremities were performed, then centrally adjudicated. Bayesian statistics were used to leverage the similarities between adults and adolescents. RESULTS A total of 88 adolescents were enrolled, from whom 184 lower extremity sonograms were performed. Of these, 9 adolescents developed DVT, with 1 having bilateral DVT. The frequency of DVT was 12.4% (95% credible interval: 6.1%, 20.1%), which ranged from 6.3% to 19.8% with a variability of 41.0% across units. All cases of DVT occurred in adolescents who received invasive mechanical ventilation (frequency: 16.5%; 95% credible interval 8.1%, 26.6%). DVT was associated with femoral central venous catheterization (OR 15.44; 95% credible interval 1.62, 69.05) and severe illness (OR for every 0.1 increase in risk of mortality 3.11; 95% credible interval 1.19, 6.85). DVT appears to be associated with prolonged days on support. CONCLUSIONS Our findings highlight the similarities and differences in the epidemiology of DVT between adults and adolescents. They support the conduct and inform the design of a trial of pharmacologic prophylaxis in critically ill adolescents.
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Affiliation(s)
| | | | - Matthew G Pinto
- Department of Pediatrics, New York Medical College, Valhalla, NY
| | - Simon Li
- Department of Pediatrics, New York Medical College, Valhalla, NY
| | - Erin Trakas
- Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester, NY
| | - Michael Miksa
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY
| | - Shira Gertz
- Department of Pediatrics, Saint Barnabas Medical Center, Livingston, NJ
| | - Lee A Polikoff
- Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, Providence, RI
| | - Massimo Napolitano
- Department of Diagnostic Radiology, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, NJ
| | - Adele R Brudnicki
- Department of Diagnostic Radiology, New York Medical College, Valhalla, NY
| | - Joana A Tala
- Pediatric Intensive Care Unit, Yale-New Haven Children's Hospital, New Haven, CT
| | - Cicero T Silva
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT
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13
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Hematologic Manifestations of Childhood Illness. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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14
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Piovesan D, Attard C, Monagle P, Ignjatovic V. Epidemiology of venous thrombosis in children with cancer. Thromb Haemost 2017; 111:1015-21. [DOI: 10.1160/th13-10-0827] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/12/2014] [Indexed: 11/05/2022]
Abstract
SummaryThere has been an extensive body of research focusing on the epidemiology of thrombosis in adult cancer populations; however, there is significantly less knowledge about thrombosis in paediatric cancer populations. Thrombosis is diagnosed with increasing frequency in children being treated for cancer, and there is an urgent need to increase our understanding of the epidemiology of thrombosis in this population. Currently, there are no guidelines for identification of high-risk groups, prophylaxis or management of thrombotic complications in paediatric cancer patients. We reviewed the available literature regarding the epidemiology, mechanisms, risk factors, prophylaxis and outcomes of thrombosis in children with cancer and identified areas that require further research. The reported incidence of symptomatic venous thromboembolism (VTE) in children with cancer ranges between 2.1% and 16%, while the incidence of asymptomatic events is approximately 40%. Approximately 30% of VTE in this population is associated with central venous lines (CVL). The most common location of VTE is upper and lower extremity deep venous thrombosis (43 to 50% of events, respectively), while 50% of events in ALL patients occur in the central nervous system. Key characteristics that increase the risk of thrombosis include the type of cancer, age of the patient, the presence of a CVL, presence of pulmonary/intra thoracic disease, as well as the type of chemotherapy. Outcomes for paediatric cancer patients with VTE include post-thrombotic syndrome, pulmonary embolism, recurrent thromboembolism, destruction of upper venous system and death. Prospective studies aimed at enabling risk stratification of patients are required to facilitate development of paediatric specific recommendations related to thromboprophylaxis in this population.
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15
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Cooper JD, Costello AG, Shaw PH. A Comparison of Extremity Thrombosis Rates in Adolescent and Young Adult Versus Younger Pediatric Oncology Patients at a Children's Hospital. J Adolesc Young Adult Oncol 2017; 6:62-66. [DOI: 10.1089/jayao.2016.0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- James D. Cooper
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aimee G. Costello
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peter H. Shaw
- Department of Oncology, Johns Hopkins School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
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16
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Asyyed Z, MacDonald T, Digout C, Kulkarni K. Incidence and characteristics of venous thrombotic events in pediatric cancer patients: A 20-year experience in the Maritimes, Canada. Pediatr Hematol Oncol 2017; 34:90-99. [PMID: 28537810 DOI: 10.1080/08880018.2017.1319450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Venous thrombotic events (VTE) are a well-recognized complication in pediatric cancer patients. Population-based data on the incidence and characteristics of VTE in all pediatric cancer patients are limited. This information is crucial to identify patients at high risk and design targeted interventions accordingly. The present study was designed to determine the incidence and characteristics of VTE in the pediatric oncology population. PARTICIPANTS We conducted a retrospective, population-based, cohort study of patients treated in the Maritimes, Canada between 1995 and 2015. RESULTS There were 1210 pediatric hematology/oncology patients from the Maritimes, Canada, treated at the IWK Health Centre between 1995 and 2015. Fifty-eight (4.8%) experienced at least 1 VTE and the majority of patients experienced it within 6 months of cancer diagnosis. The median age of patients who experienced VTE was 10.7 years (SD = 6.0). The most common presenting symptom of thrombosis was central venous line dysfunction, and the most common location for thrombosis was within the upper venous system. We observed that 65.6% of the patients with VTE required >1 central venous catheters (CVC). The presence of a VTE increased the odds of requiring >1 CVC to 3.6 (95% confidence interval: 1.76-7.3). CONCLUSION Thus, in this large, population-based study, we present the incidence and characteristics of VTE in the pediatric oncology population and demonstrate the clinical impact of VTE in terms of loss of CVC. Larger, prospective studies are required to confirm these findings and to develop a risk model for managing and preventing VTE in this patient population.
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Affiliation(s)
- Zeina Asyyed
- a Division of Hematology Oncology, Department of Pediatrics , IWK Health Centre , Halifax , Nova Scotia
| | - Tamara MacDonald
- a Division of Hematology Oncology, Department of Pediatrics , IWK Health Centre , Halifax , Nova Scotia
| | - Carol Digout
- a Division of Hematology Oncology, Department of Pediatrics , IWK Health Centre , Halifax , Nova Scotia
| | - Ketan Kulkarni
- a Division of Hematology Oncology, Department of Pediatrics , IWK Health Centre , Halifax , Nova Scotia
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17
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Ko RH, Thornburg CD. Venous Thromboembolism in Children with Cancer and Blood Disorders. Front Pediatr 2017; 5:12. [PMID: 28220143 PMCID: PMC5292750 DOI: 10.3389/fped.2017.00012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/18/2017] [Indexed: 01/19/2023] Open
Abstract
Venous thromboembolism (VTE) in children is multifactorial and most often related to a combination of inherited and acquired thrombophilias. Children with cancer and blood disorders are often at risk for VTE due to disease-related factors such as inflammation and abnormal blood flow and treatment-related factors such as central venous catheters and surgery. We will review risk factors for VTE in children with leukemia, lymphoma, and solid tumors. We will also review risk factors for VTE in children with blood disorders with specific focus on sickle cell anemia and hemophilia. We will present the available evidence and clinical guidelines for prevention and treatment of VTE in these populations.
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Affiliation(s)
| | - Courtney D Thornburg
- Hemophilia and Thrombosis Treatment Center, Rady Children's Hospital San Diego , San Diego, CA , USA
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18
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Srivaths L, Dietrich JE. Prothrombotic Risk Factors and Preventive Strategies in Adolescent Venous Thromboembolism. Clin Appl Thromb Hemost 2016; 22:512-9. [DOI: 10.1177/1076029616631428] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Venous thromboembolism (VTE) in adolescents is a serious condition that requires prompt recognition and optimal management to prevent mortality and long-term morbidity. Adolescents account for a large proportion of cases of VTE in children. As teenagers transition from childhood to adulthood, they are at risk of developing medical conditions and exposure to risky habits that predispose them to VTE. This review focuses on the variety of risk factors and comorbidities seen in adolescent VTE and takes a quick look into risk-based preventive strategies for primary and secondary prevention.
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Affiliation(s)
- Lakshmi Srivaths
- Department of Pediatrics, Section of Hematology/Oncology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Jennifer E. Dietrich
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric and Adolescent Gynecology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
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19
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Abstract
Acute lymphoblastic leukemia (ALL) is the most common pediatric oncologic diagnosis, and advances in its treatment have led to progressive improvements in survival. The 4 main components of therapy are remission induction, consolidation, maintenance, and central nervous system-directed therapy, and usually last 2 to 3 years. Treatment intensity based on risk-based stratification is the cornerstone of treatment. Patients with features of more favorable disease are spared the more toxic effects of chemotherapy, whereas more aggressive regimens are reserved for those with higher-risk disease. Prognosis of relapsed pediatric ALL depends primarily on duration of remission and site of relapse.
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Affiliation(s)
- Stacy L. Cooper
- Pediatric Hematology/Oncology, Johns Hopkins/National Institutes of Health, Bloomberg 11379, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Patrick A. Brown
- Pediatric Leukemia Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans Street, CRB1 Room 2M49, Baltimore, MD 21231, USA,Corresponding author.
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20
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Single institutional experience of prevalence and risk factors of thromboembolic events in children with solid tumors. Blood Coagul Fibrinolysis 2014; 25:333-9. [DOI: 10.1097/mbc.0000000000000038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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21
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Takemoto CM, Sohi S, Desai K, Bharaj R, Khanna A, McFarland S, Klaus S, Irshad A, Goldenberg NA, Strouse JJ, Streiff MB. Hospital-associated venous thromboembolism in children: incidence and clinical characteristics. J Pediatr 2014; 164:332-8. [PMID: 24332452 DOI: 10.1016/j.jpeds.2013.10.025] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 09/09/2013] [Accepted: 10/09/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine incidence and clinical characteristics of hospital-associated venous thromboembolism (VTE) in pediatric patients. STUDY DESIGN A retrospective analysis of patients with hospital-associated VTE at the Johns Hopkins Hospital from 1994 to 2009 was performed. Clinical characteristics of patients aged 21 years and younger who developed VTE symptoms after 2 days of hospitalization or <90 days after hospital discharge were examined. International Classification of Diseases, Ninth Revision codes were used to categorize patients with complex chronic medical conditions and trauma. RESULTS There were 270 episodes of hospital-associated VTE in 90,485 admissions (rate 30 per 10,000 admissions). Young adults (18-21 years) and adolescents (14-17 years) had significantly increased rates of VTE compared with children (2-9 years) (incidence rate ratio [IRR] 7.7, 95% CI 5.1-12.0; IRR 4.3, 95% CI 2.7-6.8, respectively). A central venous catheter (CVC) was present in 50% of patients, and a surgical procedure was performed in 45% of patients before VTE diagnosis. For patients without a CVC, trauma was the most common admitting diagnosis. CVC-related VTE was diagnosed most frequently in infants (<1 year old) and in patients with malignancy. Renal and cardiac diseases were associated with the highest rates of VTE (51 and 48 per 10,000, respectively). Rates were significantly higher among those with ≥ 4 medical conditions compared with those with 1 medical condition (IRR 4.0, 95% CI 1.4-8.9). CONCLUSION Older age and multiple medical conditions were associated with increased rates of hospital-associated VTE. These data can contribute to the design of future clinical trials to prevent hospital-associated VTE in high-risk children.
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Affiliation(s)
| | - Sajeet Sohi
- Division of Pediatric Hematology, Johns Hopkins University, Baltimore, MD
| | - Kruti Desai
- Division of Pediatric Hematology, Johns Hopkins University, Baltimore, MD
| | - Raman Bharaj
- Division of Pediatric Hematology, Johns Hopkins University, Baltimore, MD
| | - Anuj Khanna
- Division of Pediatric Hematology, Johns Hopkins University, Baltimore, MD
| | - Susan McFarland
- Division of Quality and Safety, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Sybil Klaus
- Division of Quality and Safety, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Alia Irshad
- Division of Quality and Safety, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Neil A Goldenberg
- Division of Pediatric Hematology, Johns Hopkins University, Baltimore, MD; Pediatric Thrombosis Program, All Children's Hospital-Johns Hopkins Medicine, St. Petersburg, FL
| | - John J Strouse
- Division of Pediatric Hematology, Johns Hopkins University, Baltimore, MD; Division of Adult Hematology, The Johns Hopkins Hospital, Baltimore, MD
| | - Michael B Streiff
- Division of Adult Hematology, The Johns Hopkins Hospital, Baltimore, MD
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22
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Athale U. Thrombosis in pediatric cancer: identifying the risk factors to improve care. Expert Rev Hematol 2014; 6:599-609. [DOI: 10.1586/17474086.2013.842124] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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23
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Audino AN, Yeager ND, Asti L, Miao Y, O'Brien SH. Length of stay and treatment-related complications are similar in pediatric and AYA patients with bone sarcoma in United States children's hospitals. Pediatr Blood Cancer 2013; 60:415-9. [PMID: 22706952 DOI: 10.1002/pbc.24231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 05/21/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adolescent and young adult (AYA) cancer patients have been shown to have unique clinical characteristics and inferior outcomes compared to younger patients. More than 2,500 new bone sarcomas are diagnosed yearly in the US, many of whom are AYAs treated at pediatric hospitals. Pediatric providers must understand the impact of increasing age on complications, costs, and outcomes. The study set-out to determine if AYA patients with bone sarcomas have increased healthcare utilization and treatment-related complications as compared to younger patients. PROCEDURE Data were obtained from the Pediatric Health Information System for bone sarcoma admissions at 41 US children's hospitals from 2006 to 2010. Patient demographics and morbidities were compared in patients 0-14 and 15-28 years using two sample t-tests, Wilcoxon two sample tests, or chi-squared tests. RESULTS We identified 835 pediatric and 562 AYA patients with bone sarcomas. Mean length of stay (LOS) was comparable between age groups (4.6 and 4.8 days, P = 0.46), although AYA patients had greater mean pharmaceutical charges ($18,124 vs. $13,637, P < 0.0001). Common treatment-related complications were similar between groups, with the exceptions that febrile neutropenia admissions were more likely in younger patients, and thrombosis, renal failure, and pain were more common in AYA patients. CONCLUSIONS In US children's hospitals, AYA patients with sarcomas do not have prolonged LOS or an increased risk of the most common treatment-related complications as compared to younger patients. Chronic pain appears to be a greater burden in AYA patients, and may account for their higher inpatient pharmaceutical costs.
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Affiliation(s)
- Anthony N Audino
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/The Ohio State University, Columbus, Ohio, USA
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24
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Lin CY, Chang HY, Lin SP, Chiu NC, Wang NL. Migration of a port-a-cath from the femoral vein into the duodenum 10 months after implantation. J Pediatr 2012; 161:165.e1. [PMID: 22483602 DOI: 10.1016/j.jpeds.2012.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Chien-Yu Lin
- Department of Pediatrics, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan
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25
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Kerlin BA. Current and future management of pediatric venous thromboembolism. Am J Hematol 2012; 87 Suppl 1:S68-74. [PMID: 22367975 DOI: 10.1002/ajh.23131] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 01/17/2012] [Accepted: 01/18/2012] [Indexed: 01/17/2023]
Abstract
Venous thromboembolism (VTE) is an increasingly common complication encountered in tertiary care pediatric settings. The purpose of this review is to summarize the epidemiology, current and emerging pharmacotherapeutic options, and management of this disease. Over 70% of VTE occur in children with chronic diseases. Although they are seen in children of all ages, adolescents are at greatest risk. Pediatric VTE is associated with an increased risk of in-hospital mortality; recurrent VTE and post-thrombotic syndrome are commonly seen in survivors. In recent years, anticoagulation with low molecular weight heparin has emerged as the mainstay of therapy, but compliance is limited by its onerous subcutaneous administration route. New anticoagulants either already approved for use in adults or in the pipeline offer the possibility of improved dose stability and oral routes of administration. Current recommended anticoagulation course durations are derived from very limited case series and cohort data, or extrapolations from adult literature. However, the pathophysiologic underpinnings of pediatric VTE are dissimilar from those seen in adults and are often variable within groups of pediatric patients. Clinical studies and trials in pediatric VTE are underway which will hopefully improve the quality of evidence from which therapeutic guidelines are derived.
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Affiliation(s)
- Bryce A Kerlin
- Division of Hem/Onc/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA.
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26
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Stenger MR, Slaughter JL, Kelleher K, Shepherd EG, Klebanoff MA, Reagan P, Nelin LD, Gardner W. Hospital variation in nitric oxide use for premature infants. Pediatrics 2012; 129:e945-51. [PMID: 22412028 PMCID: PMC3313635 DOI: 10.1542/peds.2011-1809] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe inter-center hospital variation in inhaled nitric oxide (iNO) administration to infants born prior to 34 weeks' gestation at US children's hospitals. METHODS This was a retrospective cohort study using the Pediatric Health Information System to determine the frequency, age at first administration, and length of iNO use among 22 699 consecutive first admissions of unique <34 weeks' gestation infants admitted to 37 children's hospitals from January 1, 2007, through December 31, 2010. RESULTS A total of 1644 (7.2%) infants received iNO during their hospitalization, with substantial variation in iNO use between hospitals (range across hospitals: 0.5%-26.2%; P < .001). The age at which iNO was started varied by hospital (mean: 20.0 days; range: 6.0-65.1 days, P < .001), as did the duration of therapy (mean: 13.1 days; range: 1.0-31.1 days; P < .001). Preterm infants who received iNO were less likely to survive (36.3% mortality vs 8.3%; odds ratio: 6.27; P < .001). The association between the use of iNO and mortality persists in propensity score-adjusted analyses controlling for demographic factors and diagnoses associated with the use of iNO (odds ratio: 3.79; P < .0001). CONCLUSIONS iNO practice patterns in preterm infants varied widely among institutions. Infants who received iNO were less likely to survive, suggesting that iNO is used in infants already at high risk of death. Adherence to National Institutes of Health consensus guidelines may decrease variation in iNO use.
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Affiliation(s)
- Michael R. Stenger
- Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children’s Hospital, Columbus, Ohio
| | - Jonathan L. Slaughter
- Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children’s Hospital, Columbus, Ohio;,Ohio Perinatal Research Network, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio; and
| | - Kelly Kelleher
- Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children’s Hospital, Columbus, Ohio;,Ohio Perinatal Research Network, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio; and
| | - Edward G. Shepherd
- Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children’s Hospital, Columbus, Ohio
| | - Mark A. Klebanoff
- Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children’s Hospital, Columbus, Ohio;,Ohio Perinatal Research Network, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio; and
| | - Patricia Reagan
- Department of Economics, The Ohio State University, Columbus, Ohio
| | - Leif D. Nelin
- Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children’s Hospital, Columbus, Ohio;,Ohio Perinatal Research Network, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio; and
| | - William Gardner
- Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children’s Hospital, Columbus, Ohio;,Ohio Perinatal Research Network, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio; and
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