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Xie W, Xu B, Lou X, Zhu J, Ye S. Development and validation of a nomogram for catheter-related thrombosis prediction in children with central venous catheter: a retrospective observational study. BMC Pediatr 2024; 24:534. [PMID: 39164645 PMCID: PMC11334387 DOI: 10.1186/s12887-024-05008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/13/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Catheter-related thrombosis (CRT) is a thrombotic complication associated with using central venous catheters (CVCs). Although risk factors for CRT were identified in children, no nomograms or predictive tools are available for the pediatric population with CVCs. This study aimed to develop and validate a prediction model of asymptomatic CRT in children with CVCs. METHODS This retrospective observational study included consecutive pediatric patients who admitted to the Children's Hospital Zhejiang University School of Medicine and received CVCs between October and December 2021. RESULTS This study included 669 patients, 553 (314 males, aged 22.00 [0.36, 180.00] months, 62 with CRT) were in the training set, and 116 (62 males, aged 15.00 [1.13, 156.00] months, 16 with CRT) were in the validation set. Multivariate logistic regression showed that a catheter time of 0-3 days (OR = 0.201, 95%CI: 0.081-0.497, P = 0.001), catheter time of 4-7 days (OR = 0.412, 95%CI: 0.176-0.964, P = 0.041), male (OR = 3.976, 95%CI: 1.864-4.483, P < 0.001), congenital heart diseases (OR = 0.277, 95%CI: 0.078-0.987, P = 0.048), postoperative (OR = 0.161, 95%CI: 0.072-0.360, P < 0.001), and femoral CVC (OR = 2.451, 95%CI: 1.129-5.318, P = 0.002) were independently associated with CRT. The nomogram incorporating these variables showed relatively good discrimination (AUC = 0.77, 95%CI: [0.65, 0.90]) and calibration abilities in the validation set, and the decision curve analysis (DCA) yielded a clinical net benefit. CONCLUSION A prediction model for CRT in children with CVC was established based on catheter time, sex, diseases, postoperative, and catheter vein. The nomogram based on logistic regression model showed favorable predictive performance.
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Affiliation(s)
- Wangfang Xie
- Comprehensive Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, Zhejiang, China
| | - Bin Xu
- Department of Ultrasound, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, Zhejiang, China.
| | - Xiaofang Lou
- Department of Nursing, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, Zhejiang, China
| | - Jihua Zhu
- Department of Nursing, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, Zhejiang, China
| | - Sheng Ye
- Comprehensive Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, Zhejiang, China
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Wright J, Qamar F, McLaughlin M, Jodeh DS, Amankwah E, Mosha M, Halsey J, Binitie O, Metts J, Goldenberg N, Rottgers SA. The Incidence of Thromboembolic Events During Hospitalizations Following Surgical Resection of Lower Extremity Sarcomas in Children: Utilizing the Pediatric Health Information System Database. J Pediatr Orthop 2023; 43:268-272. [PMID: 36693390 DOI: 10.1097/bpo.0000000000002357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a frequent occurrence during treatment for adults with sarcoma. The incidence and underlying risk factors of postsurgical VTE in children and adolescents undergoing resection of sarcoma are unknown. METHODS Using International Classification of Disease revision-9 diagnostic and procedure codes, the Pediatric Health Information System database was queried for patients aged 18 years and younger, discharged from 2004 to 2015 with a diagnosis of lower extremity malignant neoplasm who had a tumor resection or amputation performed during the encounter. Malignant neoplasms of the pelvic bones and soft tissues were categorized as "pelvis tumors", whereas malignant neoplasms of bone and soft tissues of the lower limbs were categorized as "lower limb tumors". Hospitalizations were evaluated for the occurrence of VTE. Demographic characteristics (age at admission, sex, race, and race/ethnicity) and incidence of VTE were reported. RESULTS There were 2400 patients identified. Of these, 19 experienced VTE (0.79%) during their surgical hospitalization encounter. By anatomic group, the rate of VTE was 1.4% (CI: 0.5%-3.2%) for tumors in the pelvis and 0.6% (CI: 0.3%-1.0%) in lower limb tumors. Categorizing by age, the incidence of VTE was 1.2% in patients aged zero to 5, 0.3% in patients 6 to 13, and 1.2% in patients 14 to 18 years old. (Table 1). The extremely low rate of VTE occurrence precluded further analysis of risk factors. CONCLUSIONS In this analysis, postsurgical VTE during hospitalization after pelvic and lower extremity sarcoma resection was an uncommon event in children and adolescents. There seemed to be an increased incidence of postsurgical VTE in pelvic tumors when compared with lower limb tumors, however, the rarity of all events precluded formal statistical analysis. A more robust data set would be required to determine if there are subsets of children and adolescents with sarcoma at higher risk of VTE that could benefit from thromboprophylaxis in the postoperative setting. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Joshua Wright
- Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Fatima Qamar
- Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Mariel McLaughlin
- Department of Plastic and Reconstructive Surgery, University of South Florida Morsani College of Medicine
| | - Diana S Jodeh
- Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Ernest Amankwah
- Data Coordinating Center for Pediatric Multicenter Studies, Institute for Clinical and Translational Research
| | - Maua Mosha
- Data Coordinating Center for Pediatric Multicenter Studies, Institute for Clinical and Translational Research
| | - Jordan Halsey
- Division of Plastic and Reconstructive Surgery, Department of Surgery
- Department of Plastic and Reconstructive Surgery, University of South Florida Morsani College of Medicine
| | - Odion Binitie
- Department of Sarcoma, Moffitt Cancer Center, Tampa, FL
| | - Jonathan Metts
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital
| | - Neil Goldenberg
- Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg
- Divisions of Hematology, Departments of Pediatrics and Medicine
| | - S Alex Rottgers
- Division of Plastic and Reconstructive Surgery, Department of Surgery
- Department of Plastic and Reconstructive Surgery, University of South Florida Morsani College of Medicine
- Division of Pediatric Plastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Papillon SC, Pennell CP, Master SA, Turner EM, Arthur LG, Grewal H, Aronoff SC. Derivation and Validation of a Machine Learning Algorithm for Predicting Venous Thromboembolism in Injured Children. J Pediatr Surg 2023; 58:1200-1205. [PMID: 36925399 DOI: 10.1016/j.jpedsurg.2023.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/10/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) causes significant morbidity in pediatric trauma patients. We applied machine learning algorithms to the Trauma Quality Improvement Program (TQIP) database to develop and validate a risk prediction model for VTE in injured children. METHODS Patients ≤18 years were identified from TQIP (2017-2019, n = 383,814). Those administered VTE prophylaxis ≤24 h and missing the outcome (VTE) were removed (n = 347,576). Feature selection identified 15 predictors: intubation, need for supplemental oxygen, spinal injury, pelvic fractures, multiple long bone fractures, major surgery (neurosurgery, thoracic, orthopedic, vascular), age, transfusion requirement, intracranial pressure monitor or external ventricular drain placement, and low Glasgow Coma Scale score. Data was split into training (n = 251,409) and testing (n = 118,175) subsets. Machine learning algorithms were trained, tested, and compared. RESULTS Low-risk prediction: For the testing subset, all models outperformed the baseline rate of VTE (0.15%) with a predicted rate of 0.01-0.02% (p < 2.2e-16). 88.4-89.4% of patients were classified as low risk by the models. HIGH-RISK PREDICTION All models outperformed baseline with a predicted rate of VTE ranging from 1.13 to 1.32% (p < 2.2e-16). The performance of the 3 models was not significantly different. CONCLUSION We developed a predictive model that differentiates injured children for development of VTE with high discrimination and can guide prophylaxis use. LEVEL OF EVIDENCE Prognostic, Level II. TYPE OF STUDY Retrospective, Cross-sectional.
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Affiliation(s)
- Stephanie C Papillon
- St. Christopher's Hospital for Children, Department of Pediatric General Thoracic, and Minimally Invasive Surgery, Philadelphia, PA 19134, USA.
| | - Christopher P Pennell
- St. Christopher's Hospital for Children, Department of Pediatric General Thoracic, and Minimally Invasive Surgery, Philadelphia, PA 19134, USA
| | - Sahal A Master
- St. Christopher's Hospital for Children, Department of Pediatric General Thoracic, and Minimally Invasive Surgery, Philadelphia, PA 19134, USA
| | - Evan M Turner
- Drexel University College of Medicine, 2900 W. Queen Lane, Philadelphia, PA 19129, USA
| | - L Grier Arthur
- St. Christopher's Hospital for Children, Department of Pediatric General Thoracic, and Minimally Invasive Surgery, Philadelphia, PA 19134, USA; Drexel University College of Medicine, 2900 W. Queen Lane, Philadelphia, PA 19129, USA
| | - Harsh Grewal
- St. Christopher's Hospital for Children, Department of Pediatric General Thoracic, and Minimally Invasive Surgery, Philadelphia, PA 19134, USA; Drexel University College of Medicine, 2900 W. Queen Lane, Philadelphia, PA 19129, USA
| | - Stephen C Aronoff
- Lewis Katz School of Medicine Temple University, Department of Pediatrics, 3223 N. Broad Street, Philadelphia, PA 19140, USA; St. Christopher's Hospital for Children, Section of Infectious Diseases, 160 E. Erie Avenue, Philadelphia, PA 19134, USA
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Successful treatment of an adolescent patient with acute subclavian vein occlusion using the Cleaner thrombectomy device. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1071638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Paget-Schroetter Syndrome is a rare condition characterized by the thrombosis of the axillary and/or subclavian vein due to repetitive activity of the upper extremity. This effect results in exertion-induced deep venous thrombosis (DVT) of the upper extremity. In the literature, it has been reported more frequently among the adult population. We aimed to introduce a 15-year-old female patient who suffered an acute DVT of the left upper extremity, and her successful treatment using the Cleaner thrombectomy device.
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Gonzalez AB, Mulet YM, Song N, Loh L, Scheinker D, Shin AY, Donnelly LF. Predictive Ability of the Braden QD Scale for Hospital-Acquired Venous Thromboembolism in Hospitalized Children. Jt Comm J Qual Patient Saf 2022; 48:513-520. [DOI: 10.1016/j.jcjq.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 10/17/2022]
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Affiliation(s)
- Jamie Shoag
- Holtz Children's Hospital, Jackson Memorial Medical Center, Miami, FL.,Division of Pediatric Hematology-Oncology, University of Miami-Miller School of Medicine, Miami, FL
| | - Joanna A Davis
- University of Miami - Hemophilia Treatment Center, Miami, FL
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Grizante-Lopes P, Garanito MP, Celeste DM, Krebs VLJ, Carneiro JDA. Thrombolytic therapy in preterm infants: Fifteen-year experience. Pediatr Blood Cancer 2020; 67:e28544. [PMID: 32710708 DOI: 10.1002/pbc.28544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To report a single-center experience with thrombolytic therapy using recombinant tissue plasminogen activator (rt-PA) in preterm neonates with severe thrombotic events, in terms of thrombus resolution and bleeding complications. STUDY DESIGN This retrospective study included 21 preterm neonates with severe venous thrombotic events admitted to the neonatal intensive care unit, identified in our pharmacy database from January 2001 to December 2016, and treated with rt-PA until complete or partial clot lysis, no-response or bleeding complications. Our primary outcome was thrombus resolution. RESULTS Twenty-one preterm neonates were treated with rt-PA for an average of 2.9 cycles. Seventeen patients (80.9%) had superior vena cava thrombosis and superior vena cava syndrome. All patients had a central venous catheter, parenteral nutrition, mechanical ventilation, and sepsis. Fifteen patients (71.4%) were extremely preterm, 11 (52.4%) were extremely low birth weight, and seven (33.3%) were very low birth weight. The patency rate was 85.7%, complete lysis occurred in 11 (52.4%) patients, and partial lysis in seven (33.3%). Minor bleeding occurred in five (23.8%) patients, three patients (14.2%) had clinically relevant nonmajor bleeding events, and major bleeding occurred in six (28%) patients. CONCLUSION In this study, the rate of thrombus resolution in preterm neonates treated with rt-PA were similar to the percentages reported in children and adolescents, with a high rate of bleeding. Therefore, rt-PA thrombolytic therapy should only be considered as a treatment option for severe life-threatening thrombosis in premature neonates for whom the benefits of the thrombolytic treatment outweigh the risks of bleeding.
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Affiliation(s)
- Priscila Grizante-Lopes
- Division of Pediatric Hematology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marlene Pereira Garanito
- Division of Pediatric Hematology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Daniele Martins Celeste
- Division of Pediatric Hematology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vera Lucia Jornada Krebs
- Division of Neonatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jorge David Aivazoglou Carneiro
- Division of Pediatric Hematology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Gill AE, Patel KN. The Role of Interventional Radiology in the Treatment of Acute Thrombosis and Chronic Veno-Occlusive Disease in Children and Adolescents. Semin Roentgenol 2019; 54:324-336. [PMID: 31706366 DOI: 10.1053/j.ro.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anne E Gill
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Atlanta, GA.
| | - Kavita N Patel
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Emory University School of Medicine, Department of Pediatrics, Atlanta, GA
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Brouwer K, Niele N, van Houten MA, Plötz FB. Aggressive imaging in young children on antithrombotic therapy with minor traumatic head injury. Am J Emerg Med 2019; 37:972-973. [DOI: 10.1016/j.ajem.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 11/30/2022] Open
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