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Fu M, Yuan Q, Yang Q, Yu Y, Song W, Qin X, Luo Y, Xiong X, Yu G. Risk factors and incidence of central venous access device-related thrombosis in hospitalized children: a systematic review and meta-analysis. Pediatr Res 2024:10.1038/s41390-024-03225-0. [PMID: 38760472 DOI: 10.1038/s41390-024-03225-0] [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: 10/06/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND The risk factors for central venous access device-related thrombosis (CRT) in children are not fully understood. We used evidence-based medicine to find the risk factors for CRT by pooling current studies reporting risk factors of CRT, aiming to guide clinical diagnosis and treatment. METHODS A systematic search of PubMed, Web of Science, Embase, Cochrane Library, Scopus, CNKI, Sinomed, and Wanfang databases was conducted. RevMan 5.4 was employed for data analysis. RESULTS The review included 47 studies evaluating 262,587 children with CVAD placement. Qualitative synthesis and quantitative meta-analysis identified D-dimer, location of insertion, type of catheter, number of lumens, catheter indwelling time, and central line-associated bloodstream infection as the most critical risk factors for CRT. Primarily due to observational design, the quality of evidence was regarded as low certainty for these risk factors according to the GRADE approach. CONCLUSION Because fewer high-quality studies are available, larger sample sizes and well-designed prospective studies are still needed to clarify the risk factors affecting CRT. In the future, developing pediatric-specific CRT risk assessment tools is important. Appropriate stratified preventive strategies for CRT according to risk assessment level will help improve clinical efficiency, avoid the occurrence of CRT, and alleviate unnecessary suffering of children. IMPACT This is the latest systematic review of risk factors and incidence of CRT in children. A total of 47 studies involving 262,587 patients were included in our meta-analysis, according to which the pooled prevalence of CRT was 9.1%. This study identified several of the most critical risk factors affecting CRT in children, including D-dimer, insertion location, type of catheter, number of lumens, catheter indwelling time, and central line-associated bloodstream infection (CLABSI).
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Affiliation(s)
- Maoling Fu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quan Yuan
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaoyue Yang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqi Yu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenshuai Song
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuli Qin
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Luo
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoju Xiong
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Genzhen Yu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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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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Perme T. Central Lines and Their Complications in Neonates: A Case Report and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 11:26. [PMID: 38255340 PMCID: PMC10814986 DOI: 10.3390/children11010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/24/2024]
Abstract
Central lines are essential devices in NICUs, used primarily in preterm neonates and critically ill term neonates. They are typically divided into non-tunnelled, tunnelled and totally implanted. In light of the increasing use of central lines in the NICU setting, monitoring of the risk factors associated with complications has to be an important part of neonatal care quality management. Presented here is a case of a preterm neonate with cardiac tamponade caused by UVC tip migration. Among complications of central lines are CLABSI, with an incidence of 3 to 21 per 1000 catheter days, and portal vein thrombosis, which is common but probably under-recognised, whereas other mechanical complications such as pericardial and pleural effusions are rare, with an incidence of less than 1%. Complications can cause injury to the neonates, as well as increase the costs of health services because of increases in the length of stay in the NICU. It is recommended that the catheter tip location is confirmed either by X-ray or ultrasonography. In order to minimise the risk of CLABSI, the use of bundles is recommended. Certain recommendations need to be followed when using different types of catheters. Future research is aimed at novel ways of central line securement to minimise mechanical complications and the use of antimicrobial catheters to reduce the rate of CLABSI.
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Affiliation(s)
- Tina Perme
- Neonatal Intensive Care Unit, Department for Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
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4
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Tian L, Su Y, Gao H, Wang L, Zeng J, Yang Q, Li W, Lin P, Gao Y, Tan X, Yang H, Feng X, Luo H, Li W, Zhang X, Wu X, Li Y. Development and validation of a nomogram model for central venous access device-related thrombosis in hospitalized children. Eur J Pediatr 2023; 182:4909-4919. [PMID: 37606700 DOI: 10.1007/s00431-023-05078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 08/23/2023]
Abstract
This study aimed to develop and validate a nomogram model of central venous access device-related thrombosis (CRT) for hospitalized children. A total of 503 consecutive cases from a hospital in Changsha City, Hunan Province were stochastically classified into the training set and internal validation set at a ratio of 7:3, and 85 consecutive cases in two hospitals in Urumqi City, Xinjiang Uygur Autonomous Region were collected as an external validation set. Univariate analysis and multivariate analysis on CRT-related risk factors of hospitalized children were conducted, a logistic regression model was employed to establish the nomogram, and the discrimination, calibration, and decision curve analysis was performed to assess the proposed nomogram model. The nomogram model involved seven independent risk factors, including blind catheterization, abnormal liver function, central line-associated bloodstream infection, infection, number of catheter lines, leukemia, and bed rest > 72 h. The discrimination results showed that the area under the receiver operating characteristic curve of the training set, internal validation set, and external validation set was 0.74, 0.71, and 0.76 respectively, and the accuracy rates of the proposed nomogram model were 79%, 72%, and 71% in the training set, internal validation set, and external validation set. The calibration results also showed that the calibration curve had great fitness for each dataset. More importantly, the decision curve suggested that the proposed nomogram model had a prominent clinical significance. CONCLUSION The nomogram model can be used as a risk assessment tool to reduce the missed diagnosis rate and the incidence of CRT in hospitalized children. WHAT IS KNOWN • Central venous access device-related thrombosis is generally asymptomatic for hospitalized children, causing the missed diagnosis of central venous access device-related thrombosis easily. • No risk prediction nomogram model for central venous access device-related thrombosis in hospitalized children has been established. WHAT IS NEW • A visual and personalized nomogram model was built by seven accessible variables (blind catheterization, abnormal liver function, central line-associated bloodstream infection, infection, number of catheter lines, leukemia, and bed rest > 72 h). • The model can effectively predict the risk of central venous access device-related thrombosis for hospitalized children.
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Affiliation(s)
- Lingyun Tian
- Department of Nursing, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yanan Su
- Reproductive Center, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Huimin Gao
- Operation Room, Xiangya Hospital of Central South University, Changsha, China
| | - Liqian Wang
- Ward of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Jiaqi Zeng
- Department of Pain, the , Third Xiangya Hospital of Central South University, Changsha, China
| | - Qiuhong Yang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Wan Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Pan Lin
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yijing Gao
- School of Nursing, Xinjiang Medical University, Urumqi, China
| | - Xin Tan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Haifan Yang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xinyu Feng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hui Luo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Weijuan Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiumin Zhang
- Department of Nursing, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Xing Wu
- Department of Nursing, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Office of hospital, the Seventh Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Yinglan Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China.
- National Clinical Research Center of Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, China.
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Kocoglu Barlas U, Ozel A, Yenice Bal M, Ozturk S. The Effect of Serum Electrolyte Levels and Infusion Treatments on the Development of Femoral Central Venous Catheter-Associated Deep Vein Thrombosis in Pediatric Intensive Care Unit. Clin Pediatr (Phila) 2023; 62:1277-1284. [PMID: 36856119 DOI: 10.1177/00099228231157956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
In this study, we aimed to determine the frequency of symptomatic central venous catheters-associated deep vein thrombosis (CVC-a DVT) among critically ill children with femoral vein implantation in our pediatric intensive care unit (PICU), and to compare the demographic factors, serum electrolyte levels, and types of the infusion treatments performed. A total of 215 patients aged 1 month to 18 years who had femoral CVC implanted between 2019 and 2021 were included in this study. The cases that were clinically symptomatic and had thrombosis diagnosed ultrasonography were accepted as CVC-a DVT (+), and the other cases were considered as CVC-a DVT (-). Of the total 215 cases, 57.2% (n = 123) were female and 42.8% (n = 92) were male. Catheters-associated deep vein thrombosis diagnosis were made in 9.8% of the cases (n = 21). The mean time to diagnose thrombosis in CVC-a DVT (+) cases was 8.33 ± 5.65 days. With regard to gender, age, blood type, intubation status, length of stay on mechanical ventilator, presence of extra hemodialysis catheter, acute and chronic disease status, number of days of PICU hospitalization, and Pediatric Risk of Mortality-3 scoring, no significant differences between CVC-a DVT (-) and CVC-a DVT (+) cases were observed (P > .05). The incidence of thrombosis in refugee cases was found to be significantly higher than in Turkish cases (P = .047; P < .05). There was no statistically significant difference between the groups in baseline, mean, and peak glucose, sodium, and magnesium values and who received magnesium, blood product, inotrope, and 3% hypertonic saline (HTS) infusion (P > .05). No effect of serum glucose, sodium, and magnesium levels on the development of CVC-a DVT was found. Magnesium, blood product, inotrope, and 3% HTS infusion treatments have not been shown to have an effect on the development of CVC-a DVT.
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Affiliation(s)
- Ulkem Kocoglu Barlas
- Pediatric Intensive Care Unit, Bagcılar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Abdulrahman Ozel
- Department of Pediatrics, Bagcılar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Merve Yenice Bal
- Department of Pediatrics, Bagcılar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Samet Ozturk
- Department of Radiology, Bagcılar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Rahimi Z, Abdolvand N, Sepehri MM, Khavanin Zadeh M. The association of vitamin-D level with catheter-related-thrombosis in hemodialysis patients: A data mining model. J Vasc Access 2023; 24:606-613. [PMID: 33719687 DOI: 10.1177/11297298211001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study aims to investigate the association of different risk factors including vitamin-D level with catheter-related-thrombosis in hemodialysis patients by applying data mining techniques. METHODS This study used the retrospectively approach and was done based on the CRISP-DM framework. The data of 1048 hemodialysis patients of Hasheminejad Kidney Center whose first catheterization was between 2014 and 2019 was used for analysis. In this study, patients with a previous history of deep venous thrombosis, thrombophilic condition, and undergone anticoagulant therapy were excluded. The decision tree J48 in WEKA software was used for modeling. The K-fold cross-validation method was also used to evaluate the classification performance. Finally, the model was evaluated by using Confusion Matrix and F-Measure. RESULTS The approved model was accurate in 70.3% of the predictions, and it demonstrated an association between patients' vitamin-D range and catheter-related-thrombosis. CONCLUSION The results indicated that in hemodialysis patients without the history of cancer or high blood pressure, vitamin-D had a significant impact on catheter related thrombosis.
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Affiliation(s)
- Zhaleh Rahimi
- Department of Management, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
| | - Neda Abdolvand
- Department of Management, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
| | - Mohammad Mehdi Sepehri
- Group of Information Technology Engineering, Department of Industrial Engineering, Tarbiat Modares University, Tehran, Iran
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Wang YJ, Lei L, Huang Y. Factors associated with venous thromboembolism in the paediatric intensive care unit: A systematic review and meta‐analysis. Nurs Crit Care 2022. [DOI: 10.1111/nicc.12813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ya Jing Wang
- West China School of Nursing, Sichuan University/Nursing Department, West China Second University Hospital Sichuan University Chengdu China
- Nursing Department West China Second University Hospital, Sichuan University Chengdu China
| | - Lei Lei
- Nursing Department West China Second University Hospital, Sichuan University Chengdu China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education Chengdu China
| | - Yan Huang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education Chengdu China
- Department of pediatric Intensive Care Unit, Nursing Department, West China second University Sichuan University Chengdu China
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Vorobev AV, Bitsadze VO, Khizroeva JK, Potapkina SA, Makatsariya NA, Rizzo G, Di Renzo GC, Blinov DV, Pankratyeva LL, Tsibizova VI. Neonatal thrombosis: risk factors and principles of prophylaxis. OBSTETRICS, GYNECOLOGY AND REPRODUCTION 2021. [DOI: 10.17749/2313-7347/ob.gyn.rep.2021.233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Data analysis on the pathogenesis and risk factors of neonatal thrombosis was carried out. The main risk factor of any neonatal thrombosis is central catheter installment, but other maternal, fetal and neonatal factors should be taken into consideration. We discuss the epidemiology of neonatal thrombosis and the main features of the hemostasis system in newborns, the most significant risk factors, including genetic and acquired thrombophilia. We consider the von Willebrand factor activity and ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) level in the development of neonatal thrombotic microangiopathy. Finally, we discuss the basic principles of prevented neonatal thrombosis by using low molecular weight heparins.
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Affiliation(s)
| | | | | | | | | | - G. Rizzo
- Sechenov University; University of Rome Tor Vergata
| | - G. C. Di Renzo
- Sechenov University; Center for Prenatal and Reproductive Medicine, University of Perugia
| | - D. V. Blinov
- Institute for Preventive and Social Medicine; Lapino Clinic Hospital, MD Medical Group
| | - L. L. Pankratyeva
- Vorokhobov City Clinical Hospital № 67, Moscow Healthcare Department; Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Health Ministry of Russian Federation
| | - V. I. Tsibizova
- Almazov National Medical Research Centre, Health Ministry of Russian Federation
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Efficacy of Early Prophylaxis Against Catheter-Associated Thrombosis in Critically Ill Children: A Bayesian Phase 2b Randomized Clinical Trial. Crit Care Med 2021; 49:e235-e246. [PMID: 33372745 PMCID: PMC7902342 DOI: 10.1097/ccm.0000000000004784] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES We obtained preliminary evidence on the efficacy of early prophylaxis on the risk of central venous catheter-associated deep venous thrombosis and its effect on thrombin generation in critically ill children. DESIGN Bayesian phase 2b randomized clinical trial. SETTING Seven PICUs. PATIENTS Children less than 18 years old with a newly inserted central venous catheter and at low risk of bleeding. INTERVENTION Enoxaparin adjusted to anti-Xa level of 0.2-0.5 international units/mL started at less than 24 hours after insertion of central venous catheter (enoxaparin arm) versus usual care without placebo (usual care arm). MEASUREMENTS AND MAIN RESULTS At the interim analysis, the proportion of central venous catheter-associated deep venous thrombosis on ultrasonography in the usual care arm, which was 54.2% of 24 children, was significantly higher than that previously reported. This resulted in misspecification of the preapproved Bayesian analysis, reversal of direction of treatment effect, and early termination of the randomized clinical trial. Nevertheless, with 30.4% of 23 children with central venous catheter-associated deep venous thrombosis on ultrasonography in the enoxaparin arm, risk ratio of central venous catheter-associated deep venous thrombosis was 0.55 (95% credible interval, 0.24-1.11). Including children without ultrasonography, clinically relevant central venous catheter-associated deep venous thrombosis developed in one of 27 children (3.7%) in the enoxaparin arm and seven of 24 (29.2%) in the usual care arm (p = 0.02). Clinically relevant bleeding developed in one child randomized to the enoxaparin arm. Response profile of endogenous thrombin potential, a measure of thrombin generation, was not statistically different between trial arms. CONCLUSIONS These findings suggest the efficacy and safety of early prophylaxis that should be validated in a pivotal randomized clinical trial.
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Luo L, Kou R, Feng Y, Xiang J, Zhu W. Cost-Effective Machine Learning Based Clinical Pre-Test Probability Strategy for DVT Diagnosis in Neurological Intensive Care Unit. Clin Appl Thromb Hemost 2021; 27:10760296211008650. [PMID: 33928796 PMCID: PMC8114755 DOI: 10.1177/10760296211008650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In order to overcome the shortage of the current costly DVT diagnosis and reduce the waste of valuable healthcare resources, we proposed a new diagnostic approach based on machine learning pre-test prediction models using EHRs. We examined the sociodemographic and clinical factors in the prediction of DVT with 518 NICU admitted patients, including 189 patients who eventually developed DVT. We used cross-validation on the training data to determine the optimal parameters, and finally, the applied ROC analysis is adopted to evaluate the predictive strength of each model. Two models (GLM and SVM) with the strongest ROC were selected for DVT prediction, based on which, we optimized the current intervention and diagnostic process of DVT and examined the performance of the proposed approach through simulations. The use of machine learning based pre-test prediction models can simplify and improve the intervention and diagnostic process of patients in NICU with suspected DVT, and reduce the valuable healthcare resource occupation/usage and medical costs.
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Affiliation(s)
- Li Luo
- 533694Business School, Sichuan University, Chengdu, China
| | - Ran Kou
- 533694Business School, Sichuan University, Chengdu, China
| | - Yuquan Feng
- 533694Business School, Sichuan University, Chengdu, China
| | - Jie Xiang
- 533694Business School, Sichuan University, Chengdu, China
| | - Wei Zhu
- 439679West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
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11
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Paterson RS, Chopra V, Brown E, Kleidon TM, Cooke M, Rickard CM, Bernstein SJ, Ullman AJ. Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review. Pediatrics 2020; 145:S243-S268. [PMID: 32482738 DOI: 10.1542/peds.2019-3474h] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). DATA SOURCES Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. STUDY SELECTION Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included. DATA EXTRACTION Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. RESULTS VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-to-vein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope. LIMITATIONS Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. CONCLUSIONS This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients.
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Affiliation(s)
- Rebecca S Paterson
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan.,Divisions of Hospital Medicine and.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Erin Brown
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Tricia M Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Steven J Bernstein
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and .,Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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12
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Makatsariya A, Bitsadze V, Khizroeva J, Vorobev A, Makatsariya N, Egorova E, Mischenko A, Mashkova T, Antonova A. Neonatal thrombosis. J Matern Fetal Neonatal Med 2020; 35:1169-1177. [PMID: 32204642 DOI: 10.1080/14767058.2020.1743668] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Neonatal thromboembolism in pediatric patients is a rare but life-threatening condition mainly caused by combinations of at least 2 prothrombotic triggering risk factors such as the central venous lines, septic condition, and prematurity. Other risk factors include asphyxia, dehydration, liver dysfunction, inflammation, and maternal condition. Neonatal hemostatic system is different from one of the older children and adults. Coagulation proteins do not cross the placenta but are synthesized in the fetus from an early stage. In the term neonate, concentrations of several procoagulant proteins, particularly the vitamin K dependent and contact factors are reduced when compared with adults. Conversely, levels of antithrombin, heparin cofactor II and protein C and S are low at birth and fibrinolysis system is characterized by the decreased level of plasminogen and alpha-1-antiplasmin, increased tissue plasminogen activator. These features all tend to be gestational dependent and are more present in the preterm infant. Primarily in this context neonates appear to be at a higher risk of thrombosis than older children. Thrombotic complications reach their peak in the group of children born at 22-27 weeks. The role of inherited thrombophilic risk factors in neonatal VTE development is poorly defined. The presence of inherited and acquired thrombophilia in mother and newborn is also responsible for the development of thrombosis in neonates and should be considered. Thrombophilia in the mother can lead to increased coagulation potential and prethrombotic conditions during pregnancy, causing thrombotic vasculopathy at the placental level. The benefit of identifying thrombophilia in the sick preterm newborns who are in the group of risk for development of thrombotic complications may facilitate the thromboprophylaxis. Further research regarding assessment of risk factors, diagnostics and treatment strategy is required.
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Affiliation(s)
- Alexander Makatsariya
- Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Viktoriya Bitsadze
- Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Jamilya Khizroeva
- Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alexander Vorobev
- Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Natalya Makatsariya
- Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Elena Egorova
- Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alexander Mischenko
- Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Tamara Mashkova
- Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alexandra Antonova
- Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Analysis of Patient Characteristics and Risk Factors for Thrombosis After Surgery for Congenital Heart Disease. Pediatr Crit Care Med 2018; 19:1146-1152. [PMID: 30234677 DOI: 10.1097/pcc.0000000000001743] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Thrombosis is a cause of morbidity in 4-15% of children who undergo pediatric cardiac surgery. Data on how to prevent this complication are sorely needed. We aimed to identify risk factors for thrombosis following pediatric cardiac surgery and determine if use of low molecular weight heparin prophylaxis is associated with a reduction in thrombosis risk. DESIGN Retrospective cohort study. SETTING Tertiary pediatric cardiovascular ICU. PATIENTS Patients who underwent cardiac surgery between June 2014 and December 2015. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data from patients with venous or arterial thrombosis confirmed by radiologic studies were matched two-to-one to controls based on age, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category, and gender. Thrombosis was detected in 33 patients (6.2%): 25 patients (76%) had venous thromboses, five patients (15%) had arterial thromboses, and three patients (9%) had both. Median time to thrombosis detection was 13 days (25-75%; 7-31 d). On multivariate analysis, which included adjustment for postoperative disease severity, fresh frozen plasma exposure was independently associated with thrombosis (odds ratio, 3.7; 95% CI, 1.4-9.4). Twenty-eight patients (85%) had central venous catheter-related thromboses. Low molecular weight heparin prophylaxis use in this subset of patients was not statistically different from controls (50% vs 45%, respectively; p = 0.47). On multivariable analysis, fresh frozen plasma exposure was also independently associated with central venous catheter-related thrombosis (odds ratio, 3.6; 95% CI, 1.2-10.6). CONCLUSIONS The occurrence of thrombosis after pediatric cardiac surgery at our institution was 6.2%, similar to what has been reported in other studies, despite frequent use of low molecular weight heparin. Further study is needed to determine the role of low molecular weight heparin for thromboprophylaxis and the relationship between fresh frozen plasma and thrombosis risk in children who undergo cardiac surgery.
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14
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The natural history of asymptomatic central venous catheter-related thrombosis in critically ill children. Blood 2018; 133:857-866. [PMID: 30377196 DOI: 10.1182/blood-2018-05-849737] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/24/2019] [Indexed: 02/06/2023] Open
Abstract
Asymptomatic central venous catheter (CVC)-related thrombosis in children varies in incidence from 5% to 69%. The rate of acute and long-term complications, such as postthrombotic syndrome (PTS), from asymptomatic CVC-related thrombosis is unknown. This article reports the outcomes of a prospective study of 189 children in pediatric intensive care that aimed to determine the frequency of asymptomatic CVC-related thrombosis during hospital admission, and the incidence of residual CVC-related thrombosis and clinically significant PTS 2 years later. Risk factors associated with CVC-related thrombosis were also identified. This study is distinct from previous work as children identified to have asymptomatic CVC-related thrombosis were not treated (clinical team kept blinded) and the entire cohort was followed for 2 years to determine the natural history of asymptomatic thrombosis. Ultrasounds of 146 children determined a 21.9% incidence of acute CVC-related thrombosis. Two children were symptomatic. No radiological thrombosis extension or clinical embolization occurred in the 126 children assessed at follow-up. Using 2 recognized PTS scales, clinically significant PTS was reported in 2 children (1 symptomatic, 1 asymptomatic CVC-related thrombosis), however, neither had functional impairment. Cardiac arrest was a risk factor for CVC-related thrombosis during admission and femoral CVC placement was predictive of residual thrombosis 2 years later. This study challenges the notion that critically ill children with asymptomatic CVC-related thrombosis require anticoagulant treatment, as the results demonstrate that the incidence of acute or long-term complications is low. A larger confirmatory study of nontreatment of CVC-related thrombosis in critically ill children is justified.
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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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16
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Cairo SB, Lautz TB, Schaefer BA, Yu G, Naseem HUR, Rothstein DH. Risk factors for venous thromboembolic events in pediatric surgical patients: Defining indications for prophylaxis. J Pediatr Surg 2018; 53:1996-2002. [PMID: 29370891 DOI: 10.1016/j.jpedsurg.2017.12.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/24/2017] [Accepted: 12/14/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) in pediatric surgical patients is a rare event. The risk factors for VTE in pediatric general surgery patients undergoing abdominopelvic procedures are unknown. STUDY DESIGN The American College of Surgeon's National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2012-2015) was queried for patients with VTE after abdominopelvic general surgery procedures. Patient and operative variables were assessed to identify risk factors associated with VTE and develop a pediatric risk score. RESULTS From 2012-2015, 68 of 34,813 (0.20%) patients who underwent abdominopelvic general surgery procedures were diagnosed with VTE. On multivariate analysis, there was no increased risk of VTE based on concomitant malignancy, chemotherapy, inflammatory bowel disease, or laparoscopic surgical approach, while a higher rate of VTE was identified among female patients. The odds of experiencing VTE were increased on stepwise regression for patients older than 15 years and those with preexisting renal failure or a diagnosis of septic shock, patients with American Society of Anesthesia (ASA) classification ≥ 2, and for anesthesia time longer than 2 h. The combination of age > 15 years, ASA classification ≥ 2, anesthesia time > 2 h, renal failure, and septic shock was included in a model for predicting risk of VTE (AUC = 0.907, sensitivity 84.4%, specificity 88.2%). CONCLUSION VTE is rare in pediatric patients, but prediction modeling may help identify those patients at heightened risk. Additional studies are needed to validate the factors identified in this study in a risk assessment model as well as to assess the efficacy and cost-effectiveness of prophylaxis methods. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202.
| | - Timothy B Lautz
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611
| | - Beverly A Schaefer
- Department of Pediatric Hematology and Oncology, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202; Department of Pediatrics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263; Department of Pediatrics, State University of New York, University at Buffalo, 3435 Main Street, Buffalo, NY 14214
| | - Guan Yu
- Department of Biostatistics, State University of New York, University at Buffalo, 3435 Main Street, Buffalo, NY 14214
| | - Hibbut-Ur-Rauf Naseem
- Department of Pediatric Surgery, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202
| | - David H Rothstein
- Department of Pediatric Surgery, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202; Department of Surgery, State University of New York, University at Buffalo, 3435 Main Street, Buffalo, NY 14214
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