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Ullman A, Hyun A, Gibson V, Newall F, Takashima M. Device Related Thrombosis and Bleeding in Pediatric Health Care: A Meta-analysis. Hosp Pediatr 2024; 14:e25-e41. [PMID: 38161187 DOI: 10.1542/hpeds.2023-007345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
CONTEXT The risk of invasive device-related thrombosis and bleeding contributes to morbidity and mortality, yet their prevalence by device-types is poorly understood. OBJECTIVES This study aimed to estimate pooled proportions and rates of thrombotic and bleeding complications associated with invasive devices in pediatric health care. DATA SOURCES Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. STUDY SELECTION Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) reporting thrombotic and bleeding complications, and (4) published in English, were included. DATA EXTRACTION Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. MAIN OUTCOMES AND MEASURES Device-specific pooled thromboses (symptomatic, asymptomatic, unspecified) and bleeding (major, minor). RESULTS Of the 107 studies, 71 (66%) focused on central venous access devices. Symptomatic venous thromboembolism in central venous access devices was 4% (95% confidence interval [CI], 3-5; incidence rate 0.03 per 1000 device-days, 95% CI, 0.00-0.07), whereas asymptomatic was 10% (95% CI, 7-13; incidence rate 0.25 per 1000 device-days, 95% CI, 0.14-0.36). Both ventricular assist devices (28%; 95% CI, 19-39) and extracorporeal membrane oxygenation (67%; 95% CI, 52-81) were often associated with major bleeding complications. CONCLUSIONS This comprehensive estimate of the incidence and prevalence of device-related thrombosis and bleeding complications in children can inform clinical decision-making, guide risk assessment, and surveillance.
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Affiliation(s)
- Amanda Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
| | - Areum Hyun
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Fiona Newall
- Royal Children's Hospital Melbourne, Victoria, Australia
- The University of Melbourne, Victoria, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
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Noritz G, Davidson L, Steingass K. Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy. Pediatrics 2022; 150:e2022060055. [PMID: 36404756 DOI: 10.1542/peds.2022-060055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral palsy (CP) is the most common motor disorder of childhood, with prevalence estimates ranging from 1.5 to 4 in 1000 live births. This clinical report seeks to provide primary care physicians with guidance to detect children with CP; collaborate with specialists in treating the patient; manage associated medical, developmental, and behavioral problems; and provide general medical care to their patients with CP.
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Affiliation(s)
- Garey Noritz
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
| | - Lynn Davidson
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Katherine Steingass
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
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Li H, Lu Y, Zeng X, Feng Y, Fu C, Duan H, Shu Q, Zhu J. Risk factors for central venous catheter-associated deep venous thrombosis in pediatric critical care settings identified by fusion model. Thromb J 2022; 20:18. [PMID: 35414086 PMCID: PMC9004113 DOI: 10.1186/s12959-022-00378-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 03/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background An increase in the incidence of central venous catheter (CVC)-related thrombosis (CRT) has been reported in pediatric intensive care patients over the past decade. Risk factors for the development of CRT are not well understood, especially in children. The study objective was to identify potential clinical risk factors associated with CRT with novel fusion machine learning models. Methods Patients aged 0–18 who were admitted to intensive care units from December 2015 to December 2018 and underwent at least one CVC placement were included. Two fusion model approaches (stacking and blending) were used to build a better performance model based on three widely used machine learning models (logistic regression, random forest and gradient boosting decision tree). High-impact risk factors were identified based on their contribution in both fusion artificial intelligence models. Results A total of 478 factors of 3871 patients and 3927 lines were used to build fusion models, one of which achieved quite satisfactory performance (AUC = 0.82, recall = 0.85, accuracy = 0.65) in 5-fold cross validation. A total of 11 risk factors were identified based on their independent contributions to the two fusion models. Some risk factors, such as D-dimer, thrombin time, blood acid-base balance-related factors, dehydrating agents, lymphocytes and basophils were identified or confirmed to play an important role in CRT in children. Conclusions The fusion model, which achieves better performance in CRT prediction, can better understand the risk factors for CRT and provide potential biomarkers and measures for thromboprophylaxis in pediatric intensive care settings. Supplementary information The online version contains supplementary material available at 10.1186/s12959-022-00378-y.
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Affiliation(s)
- Haomin Li
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China. .,Clinical Data Center, The Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, 310052, Hangzhou, China.
| | - Yang Lu
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Xian Zeng
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yuqing Feng
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China.,Clinical Data Center, The Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, 310052, Hangzhou, China
| | - Cangcang Fu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China.,Department of Nursing, The Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, 310052, Hangzhou, China
| | - Huilong Duan
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Qiang Shu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China
| | - Jihua Zhu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China. .,Department of Nursing, The Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, 310052, Hangzhou, China.
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Swartz MF, Hutchinson DJ, Stauber SD, Taillie ER, Alfieris GM, Cholette JM. Enoxaparin Reduces Catheter Associated Venous Thrombosis Following Infant Cardiac Surgery. Ann Thorac Surg 2021; 114:881-888. [PMID: 34062124 DOI: 10.1016/j.athoracsur.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/19/2021] [Accepted: 05/03/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Central venous catheter (CVC) related venous thrombosis (VT) following pediatric cardiac surgery increases the morbidity and mortality. Although VT prevention using low dose anticoagulation has proven ineffective, anticoagulation using high dose enoxaparin to achieve a therapeutic anti-xa level has not been studied. We hypothesized that high dose enoxaparin would reduce VT after pediatric cardiac surgery. METHODS Enoxaparin was administered to infants < 150 days when post-operative CVC duration was anticipated to extend beyond 5 days. The primary outcome was the rate of VT, re-exploration for bleeding, and post-operative red blood cell (RBC) transfusions per 1,000 CVC days. RESULTS From 2012-2019, 157 infants were treated with enoxaparin. Infants were divided into two groups: 1) SubTherapeutic (SubTher) (N = 51) - therapeutic anti-xa level (0.5-1.0 IU/mL) was not achieved, 2) Therapeutic (Ther) (N = 106) - therapeutic anti-xa level was achieved. Baseline demographics demonstrated a lower age at operation within the Ther group. The SubTher group had a higher VT rate/1,000 CVC days (8.2) compared to the Ther group (2.6; p=0.005). Re-exploration for bleeding was similar between groups. The number of post-operative RBC transfusions/1,000 CVC days was significantly greater in the SubTher group (109.4 vs. 81.6; p=0.008). Multivariate analysis demonstrated that higher median anti-xa levels reduced the risk of VT (OR 0.02, CI: 0.001, 0.63; p = 0.02). CONCLUSIONS This data suggests that enoxaparin treatment resulting in a therapeutic anti-xa level reduces post-operative CVC associated VT without increasing bleeding complications.
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Affiliation(s)
- Michael F Swartz
- Department of Surgery, University of Rochester Medical Center, Rochester, New York.
| | - David J Hutchinson
- Department of Pharmacy, University of Rochester Medical Center, Rochester, New York; Department of Pharmacy Practice, Wegmans School of Pharmacy, St. John Fisher College, Rochester, New York
| | - Sierra D Stauber
- Department of Pharmacy, University of Rochester Medical Center, Rochester, New York
| | - Eileen R Taillie
- Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester New York
| | - George M Alfieris
- Department of Surgery, University of Rochester Medical Center, Rochester, New York; Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester New York
| | - Jill M Cholette
- Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester New York
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Lu H, Yang Q, Yang L, Qu K, Tian B, Xiao Q, Xin X, Lv Y, Zheng X. The risk of venous thromboembolism associated with midline catheters compared with peripherally inserted central catheters: A systematic review and meta-analysis. Nurs Open 2021; 9:1873-1882. [PMID: 33991462 PMCID: PMC8994959 DOI: 10.1002/nop2.935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/15/2021] [Accepted: 03/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Both midline catheters (MCs) and peripherally inserted central catheters (PICCs) can cause venous thromboembolism (VTE), but the prevalence associated with each is controversial. Objective To compare the risk of VTE between MCs and PICCs with a systematic review and meta‐analysis. Methods The Web of Science Core Collection, PubMed, Scopus, Embase, the Cochrane Library and ProQuest were searched from inception to January 2020. All studies comparing the risk of VTE between MCs and PICCs were included. Selected studies were assessed for methodological quality using the Downs and Black checklist. Two authors independently assessed the literature and extracted the data. Any different opinion was resolved through third‐party consensus. Meta‐analyses were conducted to generate estimates of VTE risk in patients with MCs versus PICCs, and publication bias was evaluated with RevMan 5.3. Results A total of 86 studies were identified. Twelve studies were recruited, involving 40,871 patients. The prevalence of VTE with MCs and PICCs was 3.97% (310/7806) and 2.29% (758/33065), respectively. Meta‐analysis showed that the prevalence of VTE with MCs was higher than that with PICCs (RR=1.53, 95% CI: 1.33–1.76, p < .00001). Subgroup analyses by age showed that the prevalence of VTE with MCs was higher than that with PICCs in the adult group (RR=1.75, 95% CI: 1.38–2.22, p < .00001), and higher than that with PICCs in the other subgroups (RR=1.42, 95% CI: 1.19–1.69, p = .0001). Subgroup analyses by nation showed that the prevalence of VTE with MCs was higher than that with PICCs (RR=1.50, 95% CI: 1.30–1.73, p < .00001) in US subgroup and higher than that with PICCs (RR=2.87, 95% CI: 1.24–6.65, p = .01) in the other nations. The sensitivity analysis shows that the results from this meta‐analysis are robust and all studies have no significant publication bias. Conclusions This study provides the first systematic assessment of the risk of VTE between MCs and PICCs. MCs are associated with a higher risk of VTE than PICCs in all patients and adults. The findings of this study have several important implications for future practice. However, the risk of VTE between MCs and PICCs in children is unclear.
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Affiliation(s)
- Huapeng Lu
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Qinling Yang
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Lili Yang
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Kai Qu
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Boyan Tian
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qigui Xiao
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xia Xin
- Department of Nursing, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yi Lv
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Xuemei Zheng
- Department of Nursing, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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