Screening and Prophylaxis for Venous Thromboembolism in Pediatric Surgery: A Systematic Review.
Document Type
Article
Publication Date
10-2024
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 children25. 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.
Publication Title
Journal of pediatric surgery
Volume
59
Issue
10
First Page
161585
Last Page
161585
Recommended Citation
Kelley-Quon, L., Acker, S., St Peter, S., Goldin, A., Yousef, Y., Ricca, R., Mansfield, S., Sulkowski, J., Huerta, C., Lucas, D., Rialon, K., Christison-Lagay, E., Ham, P., Rentea, R., Beres, A., Kulaylat, A., Chang, H., Polites, S., Diesen, D., Gonzalez, K., Wakeman, D., & Baird, R. (2024). Screening and Prophylaxis for Venous Thromboembolism in Pediatric Surgery: A Systematic Review.. Journal of pediatric surgery, 59 (10), 161585-161585. https://doi.org/https://doi.org/10.1016/j.jpedsurg.2024.05.015