In the absence of a central venous catheter, the risk of venous thromboembolism (VTE) is low in trauma patients who are age 21 or less due to the high risk of VTE in hospitalized adult trauma patients, administration of the anticoagulant heparin as a preventive measure has become the standard of care for this group.
The term, "venous thromboembolism," is used for both pulmonary embolism (a sudden blockage in a lung artery) and deep vein thrombosis (a blood clot in the deep veins of the body, most often in the leg). However, due to the relative rarity of VTE, and the possibility of bleeding from medicine to prevent blood coagulation, it is recommended that only the highest risk trauma patients receive anticoagulants. A new study concludes that the risk of VTE in children, adolescents, and young adults who are hospitalized for trauma is low.
Sarah H. O'Brien, M.D., and Sean D. Candrilli, Ph.D., of Nationwide Children's Hospital and The Ohio State University College of Medicine, looked at outcomes of 135,032 patients aged 21 or younger in the National Trauma Data Bank, who spent at least one day in a critical care unit during a trauma admission between 2001 and 2005. They found that VTE was uncommon (6 cases per 1,000 discharges). The major risk factors for VTE for this population are similar to those for adults: a high injury severity score, older age, and the presence of a central venous catheter (CVC). CVC placement especially was a strong risk factor for VTE in critical care adolescent and young adult trauma patients regardless of injury pattern. The risk of VTE in patients without CVC was extremely low even among older adolescents and young adults. Overall, the results suggest that the presence of CVC is the most important factor in the development of trauma-related VTE, and the importance of this factor increases with patient age.
The researchers concluded that in young patients, "major trauma" needs to be more narrowly defined, and that VTE prophylaxis is to be considered only in critically injured adolescents and young adults with a continuing need for central venous access. This study was supported in part by the Agency for Healthcare Research and Quality (HS17344).
See "In the absence of a central venous catheter, risk of venous thromboembolism is low in critically injured children, adolescents, and young adults: Evidence from the National Trauma Data Bank" by Drs. O'Brien and Candrilli, in Pediatric Critical Care Medicine 12(3), pp. 251-256, 2011.