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Kelley-Quon LI, Acker SN, St Peter S, Goldin A, Yousef Y, Ricca RL, Mansfield SA, Sulkowski JP, Huerta CT, Lucas DJ, Rialon KL, Christison-Lagay E, Ham PB, Rentea RM, Beres AL, Kulaylat AN, Chang HL, Polites SF, Diesen DL, Gonzalez KW, Wakeman D, Baird R. Screening and Prophylaxis for Venous Thromboembolism in Pediatric Surgery: A Systematic Review. J Pediatr Surg 2024:S0022-3468(24)00345-2. [PMID: 38964986 DOI: 10.1016/j.jpedsurg.2024.05.015] [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: 09/16/2023] [Revised: 05/14/2024] [Accepted: 05/28/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee conducted a systematic review to describe the epidemiology of venous thromboembolism (VTE) in pediatric surgical and trauma patients and develop recommendations for screening and prophylaxis. METHODS The Medline (Ovid), Embase, Cochrane, and Web of Science databases were queried from January 2000 through December 2021. Search terms addressed the following topics: incidence, ultrasound screening, and mechanical and pharmacologic prophylaxis. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Consensus recommendations were derived based on the best available literature. RESULTS One hundred twenty-four studies were included. The incidence of VTE in pediatric surgical populations is 0.29% (Range = 0.1%-0.48%) and directly correlates with surgery type, transfusion, prolonged anesthesia, malignancy, congenital heart disease, inflammatory bowel disease, infection, and female sex. The incidence of VTE in pediatric trauma populations is 0.25% (Range = 0.1%-0.8%) and directly correlates with injury severity, major surgery, central line placement, body mass index, spinal cord injury, and length-of-stay. Routine ultrasound screening for VTE is not recommended. Consider sequential compression devices in at-risk nonmobile, pediatric surgical patients when an appropriate sized device is available. Consider mechanical prophylaxis alone or with pharmacologic prophylaxis in adolescents >15 y and post-pubertal children <15 y with injury severity scores >25. When utilizing pharmacologic prophylaxis, low molecular weight heparin is superior to unfractionated heparin. CONCLUSIONS While VTE remains an infrequent complication in children, consideration of mechanical and pharmacologic prophylaxis is appropriate in certain populations. TYPE OF STUDY Systematic Review of level 2-4 studies. LEVEL OF EVIDENCE Level 3-4.
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Affiliation(s)
- Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Shannon N Acker
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine Aurora, CO, USA
| | - Shawn St Peter
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Adam Goldin
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Yasmine Yousef
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
| | - Robert L Ricca
- Division of Pediatric Surgery, Prisma Health Upstate, University of South Carolina, Greenville, SC, USA
| | - Sara A Mansfield
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jason P Sulkowski
- Division of Pediatric Surgery, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Carlos T Huerta
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA
| | - Donald J Lucas
- Department of Surgery, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Division of Pediatric Surgery, Naval Medical Center San Diego, CA, USA
| | - Kristy L Rialon
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Emily Christison-Lagay
- Division of Pediatric Surgery, Yale New Haven Children's Hospital, Yale School of Medicine, USA
| | - P Benson Ham
- Division of Pediatric Surgery, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, NY, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Alana L Beres
- Division of Pediatric Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia PA, USA
| | - Afif N Kulaylat
- Division of Pediatric Surgery, Penn State Children's Hospital, Hershey, PA, USA
| | - Henry L Chang
- Department of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | | | - Diana L Diesen
- Division of Pediatric Surgery, UT Southwestern, Dallas, TX, USA
| | | | - Derek Wakeman
- Division of Pediatric Surgery, University of Rochester, Rochester, NY, USA
| | - Robert Baird
- Division of Pediatric Surgery, BC Children's Hospital Vancouver Canada, University of British Columbia, Canada
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Ochoa B, McMahon L. Surgery for ulcerative colitis. Semin Pediatr Surg 2024; 33:151404. [PMID: 38615424 DOI: 10.1016/j.sempedsurg.2024.151404] [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: 04/16/2024]
Abstract
Ulcerative colitis (UC) has a more severe presentation and rapid progression in pediatric patients, resulting in a greater need for surgical intervention compared to adults. Though medical management of UC has advanced with new biologic therapies, surgery continues to play an important role when disease progresses in the form of worsened or persistent symptoms, hemodynamic instability, or sepsis. The goals of surgical management are to restore intestinal continuity with a functional pouch when possible. While the literature has been growing regarding studies of pediatric patients with UC, high level of evidence studies are limited and most recommendations are based on adult studies. Similar to adults, pediatric patients who have ileal pouches created require surveillance for recurrent disease and cancer surveillance. Unique issues for pediatric patients include monitoring of growth and appropriate transition to adult care after adolescence. This review includes indications for surgical management, overview of staged surgical approaches, and the technical details of the three-stage approach.
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Affiliation(s)
- Brielle Ochoa
- Division of Pediatric Surgery, Department of Surgery, Phoenix Children's, Phoenix, Arizona, USA
| | - Lisa McMahon
- Division of Pediatric Surgery, Department of Surgery, Phoenix Children's, Phoenix, Arizona, USA.
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3
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Grigorian A, Schubl S, Swentek L, Barrios C, Lekawa M, Russell D, Nahmias J. Similar rate of venous thromboembolism (VTE) and failure of non-operative management for early versus delayed VTE chemoprophylaxis in adolescent blunt solid organ injuries: a propensity-matched analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-023-02440-4. [PMID: 38194094 DOI: 10.1007/s00068-023-02440-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/28/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Early initiation of venous thromboembolism (VTE) chemoprophylaxis in adults with blunt solid organ injury (BSOI) has been demonstrated to be safe but this is controversial in adolescents. We hypothesized that adolescent patients with BSOI undergoing non-operative management (NOM) and receiving early VTE chemoprophylaxis (eVTEP) (≤ 48 h) have a decreased rate of VTE and similar rate of failure of NOM, compared to similarly matched adolescents receiving delayed VTE chemoprophylaxis (dVTEP) (> 48 h). METHODS The 2017-2019 Trauma Quality Improvement Program database was queried for adolescents (12-17 years of age) with BSOI (liver, kidney, and/or spleen) undergoing NOM. We compared eVTEP versus dVTEP using a 1:1 propensity score model, matching for age, comorbidities, BSOI grade, injury severity score, hypotension on arrival, and need for transfusions. We performed subset analyses in patients with isolated spleen, kidney, and liver injury. RESULTS From 1022 cases, 417 (40.8%) adolescents received eVTEP. After matching, there was no difference in matched variables (all p > 0.05). Both groups had a similar rate of VTE (dVTEP 0.6% vs. eVTEP 1.7%, p = 0.16), mortality (dVTEP 0.3% vs. eVTEP 0%, p = 0.32), and failure of NOM (eVTEP 6.7% vs. dVTEP 7.3%, p = 0.77). These findings remained true in all subset analyses of isolated solid organ injury (all p > 0.05). CONCLUSIONS The rate of VTE with adolescent BSOI is exceedingly rare. Early VTE chemoprophylaxis in adolescent BSOI does not increase the rate of failing NOM. However, unlike adult trauma patients, adolescent patients with BSOI receiving eVTEP had a similar rate of VTE and death, compared to adolescents receiving dVTEP.
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Affiliation(s)
- Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 3800 Chapman Ave, Suite 6200, Orange, CA, 92868-3298, USA.
| | - Sebastian Schubl
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 3800 Chapman Ave, Suite 6200, Orange, CA, 92868-3298, USA
| | - Lourdes Swentek
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 3800 Chapman Ave, Suite 6200, Orange, CA, 92868-3298, USA
| | - Cristobal Barrios
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 3800 Chapman Ave, Suite 6200, Orange, CA, 92868-3298, USA
| | - Michael Lekawa
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 3800 Chapman Ave, Suite 6200, Orange, CA, 92868-3298, USA
| | - Dylan Russell
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 3800 Chapman Ave, Suite 6200, Orange, CA, 92868-3298, USA
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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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Karahan F, Ünal S, Tezol Ö, Sürmeli Döven S, Durak F, Alakaya M, Mısırlıoğlu M, Yeşil E, Kıllı İ, Kurt H, Altunköprü G. Thromboprophylaxis in pediatric patients with earthquake-related crush syndrome: a single centre experience. Pediatr Surg Int 2023; 39:248. [PMID: 37584864 DOI: 10.1007/s00383-023-05540-9] [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] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Injuries increase the risk of venous thromboembolism (VTE). However, the literature on the management of anticoagulant therapy in pediatric patients with crush injury is limited. In this study, we aimed to share our experience about anticoagulant thromboprophylaxis in pediatric patients with earthquake-related crush syndrome. METHODS This study included patients who were evaluated for VTE risk after the Turkey-Syria earthquake in 2023. Since there is no specific pediatric guideline for the prevention of VTE in trauma patients, risk assessment for VTE and decision for thromboprophylaxis was made by adapting the guideline for the prevention of perioperative VTE in adolescent patients. RESULTS Forty-nine patients [25 males and 24 females] with earthquake-related crush syndrome had participated in the study. The median age of the patients was 13.5 (8.8-15.5) years. Seven patients (14.6%) who had no risk factors for thrombosis were considered to be at low risk and did not receive thromboprophylaxis. Thirteen patients (27.1%) with one risk factor for thrombosis were considered to be at moderate risk and 28 patients (58.3%) with two or more risk factors for thrombosis were considered to be at high risk. Moderate-risk patients (n = 8) and high-risk patients aged < 13 years (n = 11) received prophylactic enoxaparin if they could not be mobilized early, while all high-risk patients aged ≥ 13 years (n = 13) received prophylactic enoxaparin. CONCLUSION With the decision-making algorithm for thyromboprophylaxis we used, we observed a VTE rate of 2.1% in pediatric patients with earthquake-related crush syndrome.
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Affiliation(s)
- Feryal Karahan
- Faculty of Medicine, Department of Pediatric Hematology, Mersin University, Mersin, Turkey
| | - Selma Ünal
- Faculty of Medicine, Department of Pediatric Hematology, Mersin University, Mersin, Turkey
| | - Özlem Tezol
- Faculty of Medicine, Department of Pediatrics, Mersin University, Mersin, Turkey.
| | - Serra Sürmeli Döven
- Faculty of Medicine, Department of Pediatric Nephrology, Mersin University, Mersin, Turkey
| | - Fatma Durak
- Faculty of Medicine, Department of Pediatrics, Mersin University, Mersin, Turkey
| | - Mehmet Alakaya
- Faculty of Medicine, Department of Pediatric Intensive Care, Mersin University, Mersin, Turkey
| | - Merve Mısırlıoğlu
- Faculty of Medicine, Department of Pediatric Intensive Care, Mersin University, Mersin, Turkey
| | - Edanur Yeşil
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Mersin University, Mersin, Turkey
| | - İsa Kıllı
- Faculty of Medicine, Department of Pediatric Surgery, Mersin University, Mersin, Turkey
| | - Hakan Kurt
- Faculty of Medicine, Department of Pediatrics, Mersin University, Mersin, Turkey
| | - Gül Altunköprü
- Faculty of Medicine, Department of Pediatrics, Mersin University, Mersin, Turkey
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Rasouli Dezfouli E, Delen D, Zhao H, Davazdahemami B. A Machine Learning Framework for Assessing the Risk of Venous Thromboembolism in Patients Undergoing Hip or Knee Replacement. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2022; 6:423-441. [PMID: 36744082 PMCID: PMC9892391 DOI: 10.1007/s41666-022-00121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 02/07/2023]
Abstract
Venous thromboembolism (VTE) is a well-recognized complication that is prevalent in patients undergoing major orthopedic surgery (e.g., total hip arthroplasty and total knee arthroplasty). For years, to identify patients at high risk of developing VTE, physicians have relied on traditional risk scoring systems, which are too simplistic to capture the risk level accurately. In this paper, we propose a data-driven machine learning framework to identify such high-risk patients before they undergo a major hip or knee surgery. Using electronic health records of more than 392,000 patients who undergone a major orthopedic surgery, and following a guided feature selection using the genetic algorithm, we trained a fully connected deep neural network model to predict high-risk patients for developing VTE. We identified several risk factors for VTE that were not previously recognized. The best FCDNN model trained using the selected features yielded an area under the ROC curve (AUC) of 0.873, which was remarkably higher than the best AUC obtained by including only risk factors previously known in the medical literature. Our findings suggest several interesting and important insights. The traditional risk scoring tables that are being widely used by physicians to identify high-risk patients are not considering a comprehensive set of risk factors, nor are they as powerful as cutting-edge machine learning methods in distinguishing low- from high-risk patients.
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Affiliation(s)
| | - Dursun Delen
- Oklahoma State University, Stillwater, OK USA
- Istinye University, Istanbul, Turkey
| | - Huimin Zhao
- University of Wisconsin-Milwaukee, Milwaukee, WI USA
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Tesoro S, Gamba P, Bertozzi M, Borgogni R, Caramelli F, Cobellis G, Cortese G, Esposito C, Gargano T, Garra R, Mantovani G, Marchesini L, Mencherini S, Messina M, Neba GR, Pelizzo G, Pizzi S, Riccipetitoni G, Simonini A, Tognon C, Lima M. Pediatric robotic surgery: issues in management-expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP). Surg Endosc 2022; 36:7877-7897. [PMID: 36121503 PMCID: PMC9613560 DOI: 10.1007/s00464-022-09577-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pediatric robotic-assisted surgeries have increased in recent years; however, guidance documents are still lacking. This study aimed to develop evidence-based recommendations, or best practice statements when evidence is lacking or inadequate, to assist surgical teams internationally. METHODS A joint consensus taskforce of anesthesiologists and surgeons from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP) have identified critical areas and reviewed the available evidence. The taskforce comprised 21 experts representing the fields of anesthesia (n = 11) and surgery (n = 10) from clinical centers performing pediatric robotic surgery in the Italian cities of Ancona, Bologna, Milan, Naples, Padua, Pavia, Perugia, Rome, Siena, and Verona. Between December 2020 and September 2021, three meetings, two Delphi rounds, and a final consensus conference took place. RESULTS During the first planning meeting, the panel agreed on the specific objectives, the definitions to apply, and precise methodology. The project was structured into three subtopics: (i) preoperative patient assessment and preparation; (ii) intraoperative management (surgical and anesthesiologic); and (iii) postoperative procedures. Within these phases, the panel agreed to address a total of 18 relevant areas, which spanned preoperative patient assessment and patient selection, anesthesiology, critical care medicine, respiratory care, prevention of postoperative nausea and vomiting, and pain management. CONCLUSION Collaboration among surgeons and anesthesiologists will be increasingly important for achieving safe and effective RAS procedures. These recommendations will provide a review for those who already have relevant experience and should be particularly useful for those starting a new program.
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Affiliation(s)
- Simonetta Tesoro
- Division of Anesthesia, Analgesia, and Intensive Care, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, 35128, Padua, Italy.
| | - Mirko Bertozzi
- Department of Pediatric Surgery, IRCCS San Matteo Polyclinic, University of Pavia, Pavia, Italy
| | - Rachele Borgogni
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Fabio Caramelli
- Anesthesia and Intensive Care Unit, IRCCS Sant'Orsola Polyclinic, Bologna, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children's Hospital, Polytechnical University of Marche, Ancona, Italy
| | - Giuseppe Cortese
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Ciro Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Tommaso Gargano
- Pediatric Surgery Unit, IRCCS Policlinico Sant'Orsola, University of Bologna, Bologna, Italy
| | - Rossella Garra
- Institute of Anesthesia and Intensive Care, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giulia Mantovani
- Pediatric Anesthesia, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Laura Marchesini
- Division of Anesthesia, Analgesia, and Intensive Care, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Simonetta Mencherini
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS San Matteo Polyclinic, Pavia, Italy
| | - Mario Messina
- Division of Pediatric Surgery, Santa Maria Alle Scotte Polyclinic, University of Siena, Siena, Italy
| | - Gerald Rogan Neba
- Department of Pediatric Anesthesia and Intensive Care, Salesi Children's Hospital, Ancona, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, Vittore Buzzi' Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Simone Pizzi
- Department of Pediatric Anesthesia and Intensive Care, Salesi Children's Hospital, Ancona, Italy
| | - Giovanna Riccipetitoni
- Department of Pediatric Surgery, IRCCS San Matteo Polyclinic, University of Pavia, Pavia, Italy
| | - Alessandro Simonini
- Department of Pediatric Anesthesia and Intensive Care, Salesi Children's Hospital, Ancona, Italy
| | - Costanza Tognon
- Pediatric Anesthesia, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Mario Lima
- Pediatric Surgery Unit, IRCCS Policlinico Sant'Orsola, University of Bologna, Bologna, Italy
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Curwin J, MacNevin W, El-Hawary R, Kulkarni K. Venous Thromboembolism Prophylaxis Use by Pediatric Orthopedic Surgeons in Canada for the Pediatric Orthopedic Surgical Population. Cureus 2022; 14:e29933. [DOI: 10.7759/cureus.29933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
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9
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Practice advisory on the prevention and management of complications of pediatric regional anesthesia. J Clin Anesth 2022; 79:110725. [DOI: 10.1016/j.jclinane.2022.110725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/20/2022]
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10
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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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11
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"Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, With a Focus on Free Tissue Transfer.". Plast Reconstr Surg 2022; 150:406e-415e. [PMID: 35674517 DOI: 10.1097/prs.0000000000009325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Microsurgical free tissue transfer has been successfully implemented for various reconstructive applications in children. The goal of this study was to identify the best available evidence on perioperative management of pediatric patients undergoing free tissue transfer, and use it to develop evidence-based care guidelines. METHODS A systematic review was conducted in Pubmed, Embase, Scopus, and Cochrane Library databases. Since a preliminary search of the pediatric microsurgical literature yielded scant data with low level of evidence (LOE), pediatric anesthesia guidelines for healthy children undergoing major surgeries were also included. Exclusion criteria included: vague descriptions of perioperative care, case reports, and studies of syndromic or chronically ill children. RESULTS 204 articles were identified, and 53 met inclusion criteria. Management approaches specific to the pediatric population were used to formulate recommendations. High quality data was found for anesthesia, analgesia, fluid administration / blood transfusion, and anticoagulation (LOE 1). Lower quality evidence was identified for patient temperature (LOE 3) and vasodilator use (LOE 4). Key recommendations include: administering sevoflurane for general anesthesia, implementing a multimodal analgesia strategy, limiting preoperative fasting, restricting blood transfusions until hemoglobin < 7 g/dl unless patient is symptomatic, and reserving chemical venous thromboembolism prophylaxis for high risk patients. CONCLUSIONS Pediatric-specific guidelines are important as they acknowledge physiologic differences in children, which may be overlooked when extrapolating from adult studies. These evidence-based recommendations are a key first step toward standardization of perioperative care of pediatric patients undergoing plastic surgical procedures, including free tissue transfer, to improve outcomes and minimize complications.
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Levels of Evidence Supporting the North American and European Perioperative Care Guidelines for Anesthesiologists between 2010 and 2020: A Systematic Review. Anesthesiology 2021; 135:31-56. [PMID: 34046679 DOI: 10.1097/aln.0000000000003808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although there are thousands of published recommendations in anesthesiology clinical practice guidelines, the extent to which these are supported by high levels of evidence is not known. This study hypothesized that most recommendations in clinical practice guidelines are supported by a low level of evidence. METHODS A registered (Prospero CRD42020202932) systematic review was conducted of anesthesia evidence-based recommendations from the major North American and European anesthesiology societies between January 2010 and September 2020 in PubMed and EMBASE. The level of evidence A, B, or C and the strength of recommendation (strong or weak) for each recommendation was mapped using the American College of Cardiology/American Heart Association classification system or the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The outcome of interest was the proportion of recommendations supported by levels of evidence A, B, and C. Changes in the level of evidence over time were examined. Risk of bias was assessed using Appraisal of Guidelines for Research and Evaluation (AGREE) II. RESULTS In total, 60 guidelines comprising 2,280 recommendations were reviewed. Level of evidence A supported 16% (363 of 2,280) of total recommendations and 19% (288 of 1,506) of strong recommendations. Level of evidence C supported 51% (1,160 of 2,280) of all recommendations and 50% (756 of 1,506) of strong recommendations. Of all the guidelines, 73% (44 of 60) had a low risk of bias. The proportion of recommendations supported by level of evidence A versus level of evidence C (relative risk ratio, 0.93; 95% CI, 0.18 to 4.74; P = 0.933) or level of evidence B versus level of evidence C (relative risk ratio, 1.63; 95% CI, 0.72 to 3.72; P = 0.243) did not increase in guidelines that were revised. Year of publication was also not associated with increases in the proportion of recommendations supported by level of evidence A (relative risk ratio, 1.07; 95% CI, 0.93 to 1.23; P = 0.340) or level of evidence B (relative risk ratio, 1.05; 95% CI, 0.96 to 1.15; P = 0.283) compared to level of evidence C. CONCLUSIONS Half of the recommendations in anesthesiology clinical practice guidelines are based on a low level of evidence, and this did not change over time. These findings highlight the need for additional efforts to increase the quality of evidence used to guide decision-making in anesthesiology. EDITOR’S PERSPECTIVE
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MacNevin W, Padhye K, Alkhalife Y, Price V, El-Hawary R, Branchford BR, Stevens S, Kulkarni K. Optimizing pharmacologic thromboprophylaxis use in pediatric orthopedic surgical patients through implementation of a perioperative venous thromboembolism risk screening tool. Pediatr Blood Cancer 2021; 68:e28803. [PMID: 33219749 DOI: 10.1002/pbc.28803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/12/2020] [Accepted: 10/22/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although rare, venous thromboembolic events (VTE) are a significant challenge in pediatric orthopedic surgical patients (POSP). A VTE thromboprophylaxis screening tool was developed and implemented in POSPs at the IWK Health Centre since October 2016. OBJECTIVES This retrospective cohort study was designed to evaluate and assess the impact of the VTE thromboprophylaxis screening tool in terms of use of thromboprophylaxis in POSP. METHODS Using the tool, POSPs were screened and were categorized into risk groups. Patient groups were compared and spearman correlation analysis was performed to show the strength of association between risk factors and thromboprophylaxis. Retrospective screening of pre-algorithm patients who received thromboprophylaxis was done to further assess the screening tool. RESULTS After the implementation of the VTE thromboprophylaxis screening tool in POSPs, there was a 47.9% reduction in the use of thromboprophylaxis (P = 0.046) as compared with before. Neither VTE nor significant bleeding complications occurred before or after screening tool implementation. Compliance with the screening tool was excellent (100% of patients in the high-risk category received thromboprophylaxis). High-risk patients were more likely to have body mass index > 30 (35.7%), limited/altered mobility (57.1%), and to be undergoing a complicated/repeat surgery (64.3%). CONCLUSIONS The present study demonstrates successful implementation of a VTE thromboprophylaxis screening tool that resulted in significant reduction in use of thromboprophylaxis in POSPs with no increase in VTE or change in bleeding complications.
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Affiliation(s)
- Wyatt MacNevin
- Division of Pediatric Hematology Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Kedar Padhye
- Division of Orthopaedics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Yasser Alkhalife
- Division of Orthopaedics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Victoria Price
- Division of Pediatric Hematology Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Ron El-Hawary
- Division of Orthopaedics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Brian R Branchford
- Division of Pediatric Hematology/Oncology/Bone Marrow Transplant, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah Stevens
- Department of Anesthesiology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Ketan Kulkarni
- Division of Pediatric Hematology Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
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Bence CM, Traynor MD, Polites SF, Ha D, Muenks P, St Peter SD, Landman MP, Densmore JC, Potter DD. The incidence of venous thromboembolism in children following colorectal resection for inflammatory bowel disease: A multi-center study. J Pediatr Surg 2020; 55:2387-2392. [PMID: 32145975 DOI: 10.1016/j.jpedsurg.2020.02.020] [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: 10/11/2019] [Revised: 01/27/2020] [Accepted: 02/03/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND/PURPOSE Children with inflammatory bowel disease (IBD) have increased risk for venous thromboembolism (VTE). We sought to determine incidence and risk factors for postoperative VTE in a multicenter cohort of pediatric patients undergoing colorectal resection for IBD. METHODS Retrospective review of children ≤18 years who underwent colorectal resection for IBD from 2010 to 2016 was performed at four children's hospitals. Primary outcome was VTE that occurred between surgery and last follow-up. Factors associated with VTE were determined using univariable and multivariable analyses. RESULTS Two hundred seventy-six patients were included with median age 15 years [13,17]. Forty-two children (15%) received perioperative VTE chemoprophylaxis, and 88 (32%) received mechanical prophylaxis. DVT occurred in 12 patients (4.3%) at a median of 14 days postoperatively [8,147]. Most were portomesenteric (n = 9, 75%) with the remaining catheter-associated DVTs in extremities (n = 3, 25%). There was no association with chemoprophylaxis (p > 0.99). On Cox regression, emergent procedure [HR 18.8, 95%CI: 3.18-111], perioperative plasma transfusion [HR 25.1, 95%CI: 2.4-259], and postoperative infectious complication [HR 10.5, 95%CI: 2.63-41.8] remained predictive of DVT. CONCLUSION Less than 5% of pediatric IBD patients developed postoperative VTE. Chemoprophylaxis was not protective but rarely used. Patients with risk factors identified in this study should be monitored or given prophylaxis for VTE. LEVEL OF EVIDENCE Treatment Study, Level III.
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Affiliation(s)
- Christina M Bence
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael D Traynor
- Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Stephanie F Polites
- Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Derrick Ha
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | - Pete Muenks
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Shawn D St Peter
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John C Densmore
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - D Dean Potter
- Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
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Fernandes CJ, Fernandes CJ, Chong DY. Intraoperative Pulmonary Embolism in an Adolescent Patient with Type III Spinal Muscular Atrophy: A Case Report. JBJS Case Connect 2020; 10:e2000087. [PMID: 32773707 DOI: 10.2106/jbjs.cc.20.00087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present the case of an 11-year-old girl with spinal muscular atrophy (SMA) type III who suffered an intraoperative venous thromboembolism (VTE), leading to death during bilateral extremity contracture releases for deformity correction. CONCLUSION Given the increasing incidence of VTE in pediatric patients, further consideration should be given to broadening the patient population offerring preoperative deep vein thrombosis screening or thromboprophylaxis. Specifically, patients with previous trauma, neuromuscular disorders, and prolonged immobilization or contractures should receive special attention. In addition, SMA may cause hypercoagulability independent of its status as a neuromuscular disorder, and this link should be investigated further.
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Affiliation(s)
- Carlton J Fernandes
- 1Department of Orthopedic Surgery, University of Oklahoma, Oklahoma City, Oklahoma 2Baylor College of Medicine, Houston, Texas
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Yan J, Zhou J, Zhen J, Li L, Care Clinical Research Group ZPC. Knowledge and Awareness of Venous Thromboembolism in Intensive Care Units in Zhejiang Province, China: A Cross-Sectional Survey. Med Sci Monit 2020; 26:e923378. [PMID: 32544921 PMCID: PMC7318836 DOI: 10.12659/msm.923378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The 2009 China Intensive Care Units (ICU) prevention guidelines lack venous thromboembolism (VTE) risk assessment. This survey was conducted to assess the risk of VTE, develop and establish a diagnosis, and provide prevention and treatment guidelines for ICU VTE. Material/Methods A cross-sectional questionnaire survey of ICU doctors ICUs was conducted online in the tertiary and secondary hospitals of Zhejiang province in China. The questionnaire included VTE-related hospital hardware information, VTE awareness, knowledge, and monitoring system. Results The risk assessment rates at the time of admission and changed disease condition were 67.7% and 60.4%, respectively. D-dimer and ultrasound were commonly used for VTE screening. Heparin is preferred for short-term intravenous anticoagulant therapy, and warfarin is preferred for long-term therapy. We found that 23.53% of the ICUs have bedside ultrasound and staff for ultrasound examination, and 59.4% of the hospitals are equipped with VTE monitoring information systems. The VTE early identification specification is the key to whether the VTE assessment is performed after the patient enters the ICU. Conclusions The survey assessed the VTE risk and key VTE management elements. However, high heterogeneities were detected in the assessment. The ICU doctors have relatively limited awareness of VTE. Thus, there is an urgent need to update and standardize the ICU VTE guidelines for the prevention and treatment of VTE in China.
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Affiliation(s)
- Jing Yan
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Jia Zhou
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Junhai Zhen
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Li Li
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China (mainland)
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Prophylaxis for Pediatric Venous Thromboembolism: Current Status and Changes Across Pediatric Orthopaedic Society of North America From 2011. J Am Acad Orthop Surg 2020; 28:388-394. [PMID: 32011545 DOI: 10.5435/jaaos-d-19-00578] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Pediatric venous thromboembolism (VTE) is a concern for orthopaedic surgeons. We sought to query the Pediatric Orthopaedic Society of North America (POSNA) members on current VTE prophylaxis practice and compare those results with those of a previous survey (2011). METHODS A 35-question survey was emailed to all active and candidate POSNA members. The survey consisted of questions on personal and practice demographics; knowledge and implementation of various VTE prophylaxis protocols, mechanical and chemical VTE prophylaxis agents, and risk factors; and utilization of scenarios VTE prophylaxis agents for various clinical scenarios. One- and two-way frequency tables were constructed comparing results from the current survey and those of the 2011 survey. RESULTS Two hundred thirty-nine surveys were completed (18% respondent rate), with most respondents from an academic/university practice reporting one or two partners (>60%). Half were in practice ≥15 years, and >90% reported an almost exclusive pediatric practice. One-third of the respondents reported familiarity with their institution-defined VTE prophylaxis protocol, and 20% were aware of an institutionally driven age at which all patients receive VTE prophylaxis. The most frequently recognized risk factors to guide VTE prophylaxis were oral contraceptive use, positive family history, and obesity. Respondents indicated a similar frequency of use of a VTE prophylaxis agent (either mechanical or chemical) for spinal fusion, hip reconstruction, and trauma (60% to 65%), with lower frequency for neuromuscular surgery (34%) (P < 0.001). One hundred thirty-seven respondents had a patient sustain a deep vein thrombosis, and 66 had a patient sustain a pulmonary embolism. Compared with responses from 2011, only 20 more respondents reported familiarity with their institution VTE prophylaxis protocol (75 versus 55). In 2018, aspirin was used more frequently than in 2011 (52% versus 19%; P < 0.0001) and enoxaparin was used less frequently (20% versus 41%; P < 0.0001). DISCUSSION Over the past 7 years since the first POSNA survey on VTE prophylaxis, most POSNA members are still unaware of their institution specific VTE prophylaxis protocol. Most respondents agree that either mechanical or chemical VTE prophylaxis should be used for spinal fusion, hip reconstruction, and trauma. The use of aspirin as an agent of chemical VTE prophylaxis has increased since 2011. LEVEL OF EVIDENCE Level IV. Type of evidence: therapeutic.
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Tian L, Zhang Y, Zeng J, Wang L, Gao H, Su Y, Li Y. A bibliometric analysis of publications on venous thromboembolism in children from 1988 to 2019. Medicine (Baltimore) 2020; 99:e20114. [PMID: 32443321 PMCID: PMC7254855 DOI: 10.1097/md.0000000000020114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Venous thromboembolism (VTE) in children not only imposes a heavy burden on the medical resources and economy of the society, but also seriously affects the growth and development of children, even threaten children's lives. A large number of publications have been performed in this field in recent years. In this bibliometric analysis, publications on VTE in children were examined and analyzed to explain the present research hotspots. METHODS Articles related to VTE in children published in the PubMed database from 1988 to June 18, 2019 were selected as the research sample. BICOMB software was used to retrieve the annual publications, journals, journal source countries and the high-frequency major medical subject headings (MeSH) terms on the articles. Then, the co-word matrix was constructed by BICOMB using the selected high-frequency MeSH terms. Next, gCLUTO software was used to analyze the matrix by double clustering and visual analysis in a strategy of hotspot identification. In addition, CiteSpace software was used to perform the knowledge map of co-authors to explore the core authors. RESULTS One thousand seven hundred seventy-nine articles on VTE in children were obtained. Seven hundred ninety academic journals distributed in 58 countries have published articles on VTE in children, and the developed countries and the United States were the major force in the journal source countries. Nowak-Göttl U occupied an important position in this field. We constructed a co-word matrix composing of 37 high-frequency MeSH terms, generated visual matrix and visual hill, and classified the hot-spots into 5 aspects based on 8 categories. CONCLUSION The results show that the research trend of children's VTE has been increasing gradually, and the sound achievement has been obtained in these hotspots in relation to the area of inherited thrombophilia, prevention and control, treatment, diagnosis, prevalence, risk factors, and complication study. However, there is a lack of communication and cooperation in this field, and the gap of national and regional research results is huge. To sum up, this study provides evidence and guidance for researchers, clinicians, and educators.
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Affiliation(s)
- Lingyun Tian
- Xiangya School of Nursing, Central South University, Changsha
- School of Nursing, Anhui University of Chinese Medicine, Hefei
| | - Ying Zhang
- Infection Control Centre, Xiangya Hospital, Central South University, Changsha
| | - Jiaqi Zeng
- Xiangya School of Nursing, Central South University, Changsha
| | - Liqian Wang
- Xiangya School of Nursing, Central South University, Changsha
| | - Huimin Gao
- Xiangya School of Nursing, Central South University, Changsha
| | - Yanan Su
- Xiangya School of Nursing, Central South University, Changsha
| | - Yinglan Li
- Xiangya School of Nursing, Central South University, Changsha
- Department of Nursing, Xiangya Hospital, Central South University, Changsha, China
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Nielsen DPD, Bangalore H, Borrows E. Comments upon "Thromboprophylaxis in adult and paediatric burn patients: A survey of practice in the United Kingdom". Burns 2020; 47:479-480. [PMID: 33303263 DOI: 10.1016/j.burns.2019.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/21/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Dominic P D Nielsen
- Barts and the London School of Anaesthesia, London E1 1BB, UK; St. Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford CM1 7ET, UK.
| | - Harish Bangalore
- St. Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford CM1 7ET, UK; Great Ormond Street Hospital, Great Ormond Street, London WC2A 3JH, UK
| | - Emma Borrows
- St. Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford CM1 7ET, UK; Great Ormond Street Hospital, Great Ormond Street, London WC2A 3JH, UK
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Mets EJ, McLynn RP, Grauer JN. Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events. WORLD JOURNAL OF PEDIATRIC SURGERY 2020; 3:e000084. [DOI: 10.1136/wjps-2019-000084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 02/07/2023] Open
Abstract
BackgroundAlthough less common in adults, venous thromboembolism (VTE) in children is a highly morbid, preventable adverse event. While VTE has been well studied among pediatric hospitalized and trauma patients, limited work has been done to examine postoperative VTE in children undergoing surgery.MethodsUsing data from National Surgical Quality Improvement Project Pediatric database (NSQIP-P) from 2012 to 2016, a retrospective cohort analysis was performed to determine the incidence of, and risk factors for, VTE in children undergoing surgery. Additionally, the relationships between VTE and other postoperative adverse outcomes were evaluated.ResultsOf 361 384 pediatric surgical patients, 378 (0.10%) were identified as experiencing postoperative VTE. After controlling for patient and surgical factors, we found that American Society of Anesthesiologists (ASA) class of II or greater, aged 16–18 years, non-elective surgery, general surgery (compared with several other surgical specialties), cardiothoracic surgery (compared with general surgery) and longer operative time were significantly associated with VTE in pediatric patients (p<0.001 for each comparison). Furthermore, a majority of adverse events were found to be associated with increased risk of subsequent VTE (p<0.001).ConclusionIn a large pediatric surgical population, an incidence of postoperative VTE of 0.10% was observed. Defined patient and surgical factors, and perioperative adverse events were found to be associated with such VTE events.
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Merella F, Mossetti V. Ultrasound-guided upper and lower extremity nerve blocks in children. BJA Educ 2020; 20:42-50. [PMID: 33456929 DOI: 10.1016/j.bjae.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 01/22/2023] Open
Affiliation(s)
- F Merella
- Birmingham Children's Hospital, Birmingham, UK
| | - V Mossetti
- Regina Margherita Children's Hospital, Turin, Italy
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Odent T, de Courtivron B, Gruel Y. Thrombotic risk in children undergoing orthopedic surgery. Orthop Traumatol Surg Res 2020; 106:S109-S114. [PMID: 31859250 DOI: 10.1016/j.otsr.2019.05.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 02/02/2023]
Abstract
Children are physiologically protected against venous thromboembolism (VTE). Specific triggering events or contributing factors have been identified in the majority of reported cases, which differs from the adult pathology where 50% of the thromboses are considered "idiopathic". This is a rare disease in children with an estimated frequency of less than 1/1000. The risk is highest in neonates, then decreases and increases again around 13 years to reach the same level as adults at 16 years. The risk of VTE is clearly higher in certain situations: significant trauma, prolonged immobilization, central venous catheter, stay in intensive care unit, inherited thrombophilia, cancer, obesity, oral contraceptives, etc. Thromboprophylaxis should not be used systematically, even in adolescents. Proper hydration and early mobilization form the basis of mechanical thromboprophylaxis. A prescription is only given after careful analysis of the child's risk factors and the orthopedic context. Thrombotic risk assessment scores - which are based on expert opinion and large VTE registers but have not been evaluated in clinical studies - are currently the most reliable method to evaluate the thrombotic risk in children and to prescribe thromboprophylaxis. Low-molecular weight heparin are the most commonly used thromboprophylaxis agents in children, with good tolerance and efficacy.
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Affiliation(s)
- Thierry Odent
- Service de chirurgie orthopédique pédiatrique, université François Rabelais de Tours, PRES Centre-Val de Loire Université, hôpital Gatien-de-Clocheville, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France.
| | - Benoît de Courtivron
- Service de chirurgie orthopédique pédiatrique, université François Rabelais de Tours, PRES Centre-Val de Loire Université, hôpital Gatien-de-Clocheville, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France
| | - Yves Gruel
- Service d'Hématologie-Hémostase, université François Rabelais de Tours, PRES Centre-Val de Loire Université, hôpital Trousseau, CHRU de Tours, 37044 Tours cedex 9, France
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Rothstein DH, Cairo SB, Schaefer BA, Lautz TB. Association of perioperative red blood cell transfusion with postoperative venous thromboembolism in pediatric patients: A propensity score matched analysis. Pediatr Blood Cancer 2019; 66:e27919. [PMID: 31298495 DOI: 10.1002/pbc.27919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To examine the association between perioperative red blood cell (RBC) transfusion and postoperative venous thromboembolism (VTE) in pediatric surgical patients. METHODS Retrospective cohort study using the National Surgical Quality Improvement Project Pediatric, a validated registry of 118 United States children's hospitals. Patients under 19 years of age undergoing a surgical procedure between 2012 and 2017 were included, with the main exposure being RBC transfusion in the perioperative period (48 hours prior to operation to 72 hours after operation). The primary 30-day outcome of interest was a postoperative VTE requiring therapy. Risk-adjusted odds ratios (aOR) were calculated using multiple logistic regression. Subgroup analyses were performed across multiple surgical specialties. Sensitivity analyses were performed after (a) imputation for missing variables and (b) propensity score matching. RESULTS During the study years, 482 867 pediatric patients (56.7% male; median age, 6 years [interquartile range, 1-12 years]) underwent an operation. Of these, 30 879 (6.4%) received at least one perioperative RBC transfusion. Postoperative VTE requiring therapy occurred in 618 patients (0.13%). After adjustment for multiple risk factors, perioperative RBC transfusion was associated with an increased risk of VTE (aOR 2.4; 95% CI, 1.9-3.0). The increased VTE risk persisted after imputation of missing demographic and clinical data as well as after 1:1 propensity score matching (29 811 matched pairs, aOR 2.2; 95% CI, 1.7-2.8). CONCLUSIONS Perioperative RBC transfusion is associated with an increased, albeit still very low, risk of postoperative VTE in pediatric patients. Patients receiving blood in the perioperative period may benefit from additional monitoring or VTE prophylaxis.
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Affiliation(s)
- David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Sarah B Cairo
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York
| | - Beverly A Schaefer
- Department of Pediatric Hematology and Oncology, John R. Oishei Children's Hospital, Buffalo, New York.,Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Timothy B Lautz
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Affiliation(s)
- S Jinks
- Great Ormond Hospital NHS Foundation Trust, London, UK
| | - A Arana
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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O'Leary JD, Goobie SM. Improving venous thromboembolism management in children undergoing surgery. Paediatr Anaesth 2018; 28:378-379. [PMID: 29870137 DOI: 10.1111/pan.13349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- James D O'Leary
- Division of Cardiac Anesthesia, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Susan M Goobie
- Department of Anesthesia, Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, USA
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