Venous thromboembolism (VTE), a complication of major trauma, is rarer among young trauma patients than among adults who suffer severe trauma. VTE is an obstruction of a deep vein by a blood clot (deep venous thromboembolism), which can travel to the lungs (pulmonary embolism) or elsewhere. It can lengthen hospital stays as well as costs, independent of how severe the injury is, according to a new study. Therefore, it is important to identify patients most at risk for VTE, who would benefit from low doses of anticlotting medications to prevent VTE.
In a weighted sample of 240,387 hospital stays related to trauma in patients less than 20 years of age from the 2003 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database, the researchers identified 648 patients (2.7 per 1,000 hospital discharges) with a diagnosis of VTE. Of the young trauma patients with VTE, 22.6 percent had only a pulmonary embolism and 72.8 percent had only deep venous thrombo-embolism. An additional 4.6 percent had both types of thromboembolism. Patients with VTE were older (mean age of 16.6 years vs. 12.2 years) than trauma patients without VTE and had nearly double the injury severity score (ISS = 20.7 vs. 10.5). Mean total costs and length of stay for VTE patients ($68,865 and 22.6 days, respectively) were substantially greater than for pediatric trauma patients as a whole ($10,843 and 4.2 days, respectively).
The researchers found that critically injured patients were 3.5 times more likely to have VTE than patients with minor injuries. For example, children with severe and critical injuries, who were likely to be admitted to the ICU, made up less than 15 percent of the total trauma group, but nearly 50 percent of the trauma and VTE group. Because the rate of VTE among young trauma patients is low, and anticlotting therapy has its own risks, there is a need to determine the factors that make a pediatric trauma patient at high risk of developing VTE, the researchers conclude. The study was funded in part by the Agency for Healthcare Research and Quality (HS17344).
More details are in "Effect of injury severity on the incidence and utilization-related outcomes of venous thromboembolism in pediatric trauma inpatients," by Sean D. Candrilli, Ph.D., Rajesh Balkrishnan, Ph.D., and Sarah H. O'Brien, M.D., M.Sc., in the September 2009 Pediatric Critical Care Medicine 10(5), pp. 554-557.