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Venous Thromboembolism in Childhood
Study Questions:
What are the characteristics of venous thromboembolism (VTE), including deep vein thrombosis (DVT), pulmonary embolism (PE), cerebral sinus venous thrombosis, and renal vein thrombosis, in childhood?
Methods:
The hospital admission and discharge databases of Quebec, Canada were queried for the incidence of VTE from 1994-2004 in patients <18 years old. Only those who had been Quebec residents for ≥12 months were included, and therefore, infants <1 year of age were necessarily excluded.
Results:
Data from 487 cases (extracted from over 1.6 million Quebec residents) were analyzed. VTE had a crude incidence rate of 0.29 VTE per 10,000 children-years, with a mortality risk of 6.4%. Fifty-six percent were >15 years old, 63% were female, with 90% diagnosed to have DVT or PE. Central lines and major surgery were present in approximately 18%. Risk factors for VTE included bone marrow transplant, indwelling central line, chronic diseases including congenital heart disease, malignancy, thrombophilia, major surgery, and significant trauma and infections, as well as pregnancy. A risk factor was identified in approximately 51%.
Conclusions:
The authors concluded that VTE is frequent in the pediatric age group.
Perspective:
Historically, VTE in children was rare and as such, was not generally considered a pediatric disease. Thus, knowledge of this entity in children has been extrapolated from adult information. With advancements in care and survival of critically ill children, more of them will be diagnosed with this potentially debilitating complication. This large population-based study sheds light into the demographics, characteristics, concurrent diagnoses, and risk factors of VTE in children in the developed world. As such, it has all the innate limitations of database studies (improper coding, diagnostic inaccuracies, and retrieval challenges), in addition to one particular to this case—the exclusion of likely many medically fragile infants <1 year of age, in whom therapeutic choices for VTE are limited, challenging to monitor, and inherently fraught with complications themselves. As more information becomes available, knowledge of VTE characteristics in children may prevent its occurrence and improve diagnosis and therapeutic outcomes in cases that are unpreventable. It behooves the clinician to have a high index of suspicion for this entity, as a VTE risk factor was not identified in 50% of cases.
Keywords: Bone Marrow Transplantation, Cardiac Surgical Procedures, Chronic Disease, Heart Defects, Congenital, Incidence, Infant, Pediatrics, Pregnancy, Pulmonary Embolism, Renal Veins, Risk Factors, Thrombophilia, Vascular Diseases, Venous Thromboembolism, Venous Thrombosis
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