Promising biomarkers for the prediction of catheter-related venous thromboembolism in hospitalized children: An exploratory study

Introduction: Venous thromboembolism (VTE) is a known complication in children with inflammatory bowel disease (IBD) and can be associated with significant morbidity and mortality. Central lines, inflammation, hospital stays, and protein losses are among risk factors that contribute to this elevated risk. While it is known that children with IBD have an increased VTE risk, there are no standard guidelines for prevention of this unwanted complication. Decreasing the rate of hospital-acquired VTE in all hospitalized children is of national interest, especially in this unique patient population. However, there are no clear data regarding the true impact of VTE on the pediatric IBD population to guide practitioners in prevention and management. Given that IBD patients are known to have an increased risk of VTE, we sought to assess the burden associated with VTE development in hospitalized IBD patients. Methods: The Pediatric Health Information System database (PHIS), a database that includes both clinical and resource utilization data for over 45 children's hospitals, was utilized to gather inpatient data from 2009-2017. ICD9 (IBD - 555.xx, 556.xx and VTE - 325, 415.1x, 451.x, 452, 453.0-.9, and 572.1) and ICD10 (IBD - K50.0-.919, K51.0-.919 and VTE - I80.0-.9, I81, I82.0-.91, I63.6, I67.6) diagnostic codes for IBD and VTE were applied to identify hospitalized IBD patients who experienced a VTE event. First admissions during the time period were used to avoid capturing the same VTE event more than once. Demographic data, as well as data regarding hospitalization, were reviewed. The Institutional Review Board of Weill Cornell Medicine approved this study. Results: 19,004 first admissions were identified for patients with IBD. Of those, 475 had documented episodes of VTE, demonstrating an incidence of having a VTE at first admission of 2.5%. There were no significant differences in gender, age at first admission, ethnicity, or geographic region between hospitalized IBD patients who did and did not have a VTE event. Hospitalized IBD patients with VTE had a significantly greater median length of stay, significantly higher likelihood of ICU stay, and a significantly higher discharge mortality rate (Table 1). Children with IBD and VTE had an odds ratio of 8.63 [95% CI 7.02-10.62, p=<0.001] for ICU stay, and an odds ratio of 6.14 [95% CI 2.76-13.69, p=<0.001] for discharge mortality compared to children with IBD and no VTE. Median billed charges and total costs were significantly higher in the hospitalized IBD patients with VTE compared to those without VTE - both were approximately 3 times greater in IBD patients who developed a VTE (Table 2). When looking at the annual incidence rate of VTE among hospitalized IBD patients for first admission, rates ranged from 1.7 to 3.4 per 100 patients, with an average number of cases of 53 per year (Figure 1). Conclusion: Our data demonstrate that hospitalized children with IBD and a VTE event are at greater risk for mortality and increased likelihood of ICU stay than those without VTE. They are also shown to incur significantly higher hospital costs when compared to children without a VTE episode. Our study is limited due to the possibility of missing data due to coding errors, which can occur in large database studies such as this. Despite this limitation, our data demonstrate that a significant medical and financial burden is placed on hospitalized children with IBD who develop a VTE. Our evidence, and the work of others, support the need for larger, prospective, multi-center studies focused on prevention of VTE in hospitalized pediatric IBD patients. Disclosures Cooley: off-label: Other: drug use.

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The Experience of Patients With Cancer Who Develop Venous Thromboembolism: An Exploratory Study

Oncology Nursing Forum ◽

10.1188/12.onf.e233-e240 ◽

2012 ◽

Vol 39 (3) ◽

pp. E233-E240 ◽

Cited By ~ 8

Author(s):

Alison Mockler ◽

Brigit O'Brien ◽

Jessica Emed ◽

Gina Ciccotosto

Keyword(s):

Venous Thromboembolism ◽

Exploratory Study ◽

Patients With Cancer

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Infections Are Associated with Higher Risk of Venous Thromboembolism in Hospitalized Children with Nephrotic Syndrome

Blood ◽

10.1182/blood.v128.22.3811.3811 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3811-3811

Author(s):

Jennifer Goldman ◽

Shannon L Carpenter ◽

Ashley K Sherman ◽

David Selewski ◽

Mahmoud Kallash ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Logistic Regression ◽

Regression Analysis ◽

Nephrotic Syndrome ◽

Intensive Care ◽

Venous Thromboembolism ◽

Streptococcus Pneumoniae ◽

Hospitalized Children ◽

Median Hospital

Abstract Introduction: Although it is known that children with nephrotic syndrome (NS) are at greater risk for certain complications, the frequency of these complications and predisposing risk factors are poorly defined. In particular, nephrotic syndrome has long been considered a hypercoagulable state. Risk for development of venous thromboembolism (VTE) is known to be increased in the setting of an active infection. The objective of this study was to determine the prevalence of infection and VTE among a cohort of hospitalized children with NS, and the association of these complications on outcomes. Methods: Records of hospitalized children with NS admitted to any of 17 participating pediatric hospitals across North America from 2010-2012 were included. Data including demographics, clinical pattern of NS, renal biopsy results, number of hospitalizations, nephrotoxic medication usage, infection and VTE history were recorded. Descriptive statistics were used to determine prevalence of infection and VTE. Wilcoxon rank sum was used to perform comparisons between groups. Logistic regression analysis was utilized to determine predictors of VTE development. Results: Seven-hundred thirty hospitalizations occurred among 370 children. One-hundred forty-eight children (40%) had at least 1 infection with a total of 211 infectious episodes; 11 (3%) had VTE. Those with infection were more likely to have VTE (p = 0.0457). Infections associated with VTE were C. difficile (1 subject), methicillin sensitive S. Aureus (2), Streptococcus pneumoniae (1), and unknown (3). There were no differences between those with and without infection regarding gender or ethnicity. Those with infection were younger at NS diagnosis (3.0 vs. 4.0 years; p = 0.008), and steroid resistant NS was more highly associated with infection than all other clinical diagnoses (steroid-sensitive NS, steroid-dependent NS, other) (p = 0.003). The most common types of infections encountered included peritonitis (23%), pneumonia (22%), and bacteremia (16%). Bacterial pathogens (Streptococcus pneumoniae 41%, Escherichia coli 16%, Clostridium difficile 10%) were most commonly identified. Children with VTE, infection, or both, also required significantly more days in hospital. The median hospital stay for those without infection was 5 days vs. 10 in those with infection (p< 0.0001). Similarly, median hospital days for those without VTE were 6 days as compared to 22 in those with VTE (p < 0.0001). Of those with infection, 13% had an ICU stay compared with 3.3% of those without. Those with VTE also had a median of 4 days in the intensive care unit as compared to 0 days in those without VTE (p < 0.0001). In a logistic regression analysis, only the number of ICU days was predictive of the presence of VTE (OR 1.074, 95% CI 1.013 - 1.138). Conclusions: Children with NS who are hospitalized have high rates of infection. While the rate of VTE was not high in this cohort, presence of VTE was associated with infection. Both infection and VTE were associated with longer hospitalizations and intensive care unit stays. Streptococcus pneumoniae remains the most commonly identified bacterial pathogen in children with nephrotic syndrome, though methicillin sensitive S. Aureus was identified in 2 of 11 patients with VTE. Further studies are needed to identify potentially modifiable risk factors that could minimize these complications in this already high risk population. Disclosures No relevant conflicts of interest to declare.

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Risk factors for venous thromboembolism in hospitalized children and adolescents

Journal of Pediatric Orthopaedics B ◽

10.1097/bpb.0000000000000053 ◽

2014 ◽

Vol 23 (4) ◽

pp. 389-393 ◽

Cited By ~ 21

Author(s):

Seung-Ju Kim ◽

Sanjeev Sabharwal

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Children And Adolescents ◽

Hospitalized Children

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A música como auxílio terapêutico de crianças hospitalizadas

Revista de Enfermagem UFPE on line ◽

10.5205/1981-8963.2019.242812 ◽

2019 ◽

Vol 13 ◽

Author(s):

Eva Rodrigues de Carvalho Portugal Neta ◽

Ricardo Saraiva Aguiar

Keyword(s):

Music Therapy ◽

Exploratory Study ◽

Hospitalized Children ◽

Pediatric Hospital ◽

Health Team ◽

Pediatric Hospitals ◽

Analysis Process ◽

Analysis Technique ◽

Qualitative Descriptive ◽

Structured Questionnaire

Objetivo: analisar as repercussões da utilização da música no processo de hospitalização de crianças em um hospital pediátrico de nível terciário. Método: trata-se de um estudo qualitativo, descritivo, exploratório, por meio de uma entrevista com um questionário semiestruturado a três crianças hospitalizadas, cinco pais e/ou responsáveis legais e seis profissionais da saúde, identificados de acordo com as notas musicais (DÓ, RÉ e MI). Realizou-se o processo de análise dos dados pela técnica de Análise de Conteúdo. Resultados: verificou-se a música como uma tecnologia leve capaz de desenvolver e atingir potenciais dos integrantes da vida diária do hospital pediátrico. Acaba-se a musicalidade também empoderando a equipe de saúde de modo a favorecer a consolidação das atividades e a ampliação do valor do cuidado. Conclusão: identificou-se que a música ameniza sofrimentos e integra as crianças e familiares a um lugar que, para elas, é inseguro e desconhecido, bem como cativa, envolve e emociona. Sugere-se, desse modo, que tal estratégia possa servir de modelo a outros hospitais pediátricos. Descritores: Música; Terapêutica; Musicoterapia; Hospitalização; Enfermagem; Hospitais Pediátricos. AbstractObjective: to analyze the repercussions of the use of music in the hospitalization process of children in a tertiary pediatric hospital. Method: this is a qualitative, descriptive, exploratory study through an interview with a semi-structured questionnaire to three hospitalized children, five parents and/or legal guardians and six health professionals, identified according to musical notes (DO, RÉ and MI). The data analysis process was performed by the Content Analysis technique. Results: music was found to be a lightweight technology capable of developing and reaching potentials in the daily life of the pediatric hospital. The musicality ends also empowering the health team in order to favor the consolidation of activities and the expansion of the value of care. Conclusion: it was identified that music mitigates suffering and integrates children and family members in a place that, for them, is unsafe and unknown, as well as captivates, engages and thrills. It is therefore suggested that such a strategy could serve as a model for other pediatric hospitals. Descriptors: Music; Terapeutics; Music Therapy; Hospitalization; Nursing; Hospitals, Pediatric.ResumenObjetivo: analizar las repercusiones del uso de la música en el proceso de hospitalización de niños en un hospital pediátrico terciario. Método: este es un estudio cualitativo, descriptivo y exploratorio a través de una entrevista con un cuestionario semiestructurado a tres niños hospitalizados, cinco padres y/o tutores legales y seis profesionales de la salud, identificados de acuerdo con notas musicales (DO, RÉ y MI). El proceso de análisis de datos se realizó mediante la técnica de Análisis de Contenido. Resultados: se descubrió que la música es una tecnología liviana capaz de desarrollar y alcanzar potenciales en la vida diaria del hospital pediátrico. La musicalidad termina también empoderando al equipo de salud para favorecer la consolidación de actividades y la expansión del valor de la atención. Conclusión: se descubrió que la música disminuye el sufrimiento e integra a los niños y miembros de la familia en un lugar que, para ellos, es inseguro y desconocido, así como cautiva, involucra y emociona. Por lo tanto, se sugiere que dicha estrategia podría servir como modelo para otros hospitales pediátricos. Descriptores: Música; Terapéutica; Musicoterapia; Hospitalización; Enfermería; Hospitales Pesiátricos.

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Features assistance provided by team health children hospitalized in view of parents and companions

Revista de Enfermagem UFPE on line ◽

10.5205/reuol.1296-10059-1-le.0404spe201009 ◽

2010 ◽

Vol 4 (4) ◽

pp. 1909

Author(s):

Sinéia Dos Santos Machado ◽

Fátima Helena Cecchetto ◽

Eveline Franco Silva ◽

Fernando Riegel

Keyword(s):

Health Care ◽

Child Health ◽

Health Professionals ◽

Exploratory Study ◽

Rio Grande ◽

Ethics Committee ◽

Parental Satisfaction ◽

Hospitalized Children ◽

Rio Grande Do Sul ◽

Pediatric Center

ABSTRACTObjective: to identify the satisfaction of hospitalized children´s companion concerning the attendance provided by the health professionals. Methodology: this is about a descriptive-exploratory study from quantitative approach, developed in the pediatric center of a philanthropic hospital from the Serra Gaúcha/RS. The population was constituted of 35 children´s companion interned in the pediatric center. The data were collected through a questionnaire with structured issues and analyzed with the software Epi Info 2002. The research only had the beginning after approval of the Ethics Committee in Research of Nossa Senhora de Fatima University under protocol number 043/09. Results: the majority (82.85%) respondents reported no complaints regarding the care of the child; 17.15% escorts have any complaints about the care. Conclusion: the apparent satisfaction suggests the requirement of the humanization process. Information from the study can be used by nursing staff of the institutions, as proposed adequacy, or intensification of the promotion of health in relation to parental satisfaction during hospitalization of children. Descriptors: child health; health care; pediatric nursing.RESUMOObjetivo: identificar a satisfação dos pais de crianças hospitalizadas acerca da assistência prestada pelos profissionais de saúde. Metodologia: estudo descritivo-exploratório com abordagem quantitativa, desenvolvido no setor de internação pediátrica de um hospital filantrópico da Serra Gaúcha. A população constituiu-se de 35 sujeitos. Os dados foram coletados opor meio de questionário estruturado, analisados a partir do banco de dados do software Epi Info 2002. A investigação teve início somente após aprovação do Comitê de Ética da Faculdade Nossa Senhora de Fátima, sob parecer nº 043/09. Resultados: a maioria (82,85%) dos entrevistados referiu não ter reclamações quanto aos cuidados prestados à criança; 17,15% acompanhantes têm alguma queixa quanto aos cuidados. Conclusão: a satisfação evidenciada sugere a exigência do processo de humanização da assistência. As informações provenientes do estudo podem ser utilizadas pela equipe de enfermagem das instituições, como proposta de adequação, ou intensificação das ações de promoção da saúde, no que se refere à satisfação dos pais, durante internação de filho. Descritores: saúde da criança; assistência integral à saúde; enfermagem pediátrica.RESUMENObjetivo: identificar la satisfacción de los que acompañan a niños hospitalizados con respecto a la asistencia dado por los profesionales de la salud. Metodología: estudio descriptivo-exploratorio con un enfoque cuantitativo, que se desarrolló en la sección de internamiento pediátrico de un hospital filantrópico de la provincia de Rio Grande do Sul. La población fue constituida de 35 compañeros de niños ingresados en la sección pediátrica. Los datos fueron colectados a través de un cuestionario con los temas estructurados y analizados a partir del software Epi Info 2002. La investigación solamente empezó después de la aprobación del comité de ética en pesquisas de la facultad “Nossa Senhora de Fatima” de n º 043/09. Resultados: la mayoría (82,85%) de los encuestados no reportaron quejas con respecto a cuidado de niños; 17,15% de los compañeros tiene alguna queja sobre cuidado. Conclusión: la satisfacción sugiere el requisito del proceso de humanización. Este estudio puede ser utilizado por equipo enfermería de las instituciones, como la adecuación propuesta, o la intensificación de la promoción de la salud en relación con la satisfacción de los padres durante la hospitalización de los niños. Descriptores: salud del niño; atención integral de salud; enfermaría pediátrica.

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Current Practice Patterns of Phamacological Thromboprophylaxis for Prevention of Venous Thromboembolism in Hospitalized Children: A Survey of Pediatric Hemostasis and Thrombosis Experts in North America

Blood ◽

10.1182/blood.v124.21.4274.4274 ◽

2014 ◽

Vol 124 (21) ◽

pp. 4274-4274

Author(s):

Sherif M Badawy ◽

Anjali Sharathkumar

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Venous Thromboembolism ◽

Current Practice ◽

Practice Patterns ◽

Multiple Choice ◽

Antiphospholipid Antibody ◽

Hospitalized Children ◽

Clinical Scenarios ◽

Chronic Inflammatory Condition

Abstract Background: The prevalence of venous thromboembolism (VTE) is on the rise in critically sick hospitalized children. It is one of the most common hospital acquired complications (HAC) and Joint Commission for Accreditation for Hospitals (JCAHO) has mandated to develop institutional guidelines to prevent VTE. It is recommended to use pharmacologic thromboprophylaxis (PTP), the most effective intervention for VTE prevention, for eligible adult population. Unfortunately this strategy is not systematically evaluated in children due to sample size and recruitment issues. Therefore the risks and benefits of universal PTP in critically sick children are unclear specifically in the context of exposure to acquired risk factors including central venous lines (CVLs), age, cancer, infection and trauma/surgery. We sought to understand expert clinical decision-making. Aims: To understand the current practice patterns of pharmacological thromboprophylaxis and the perceived risks of VTE in hospitalized children. Methods: This cross-sectional self-administered multiple-choice survey questionnaire was administered to pediatric hematologists who are members of Hemostasis Thrombosis Research Society (HTRS) with at least 5 years of experience. The survey designed to collect physicians’ demographics, thromboprophylaxis policies and opinions about the use of PTP using 13 multiple choice questionnaire and 4 clinical scenarios. Results: The response rate was 47.3% [53/112]. Majority practiced at University affiliated hospitals (73%). Only 44% of respondents were in favor of adoption of universal PTP policy for children and 65% of them didn’t support thromboprophylaxis for CVL. Only one third of the participants had established policy for PTP mainly for intensive care unit, orthopedic and trauma patients. Almost all respondents (98 %) used PTP for a select patient population based on following risk factors: known inherited thrombophilia, morbid obesity, chronic inflammatory condition, history of idiopathic deep venous thrombosis (DVT), CVL related DVT, detected antiphospholipid antibody and teenagers with DVT risk factors. The factors that were not important for thromboprophylaxis included: underlying malignancy, positive blood culture, diabetic ketoacidosis, immobilization and CVLs, whether being critically sick newborns or not. Four different adolescent, child, and infant scenarios were answered by 94 % of respondents. Case (1) A newborn on mechanical ventilation with sepsis, thrombocytopenia and femoral line dysfunction without CVL-thrombosis. About 72% of respondents didn’t consider AC, 68% of them didn’t consider mechanical thromboprophylaxis. If developed MRSA sepsis and right hip osteomyelitis later on, only 42% of all respondents would not consider AC. So, in the newborns, PTP may not benefit for CVL malfunction but may be beneficial in the setting of osteomyelitis. LMWH was the preferred choice of PTP. Case (2): A 10 years old boy with a fracture femur with 4 weeks immobilization, 66 % of respondents were not in favor of AC, 69 % of them would consider mechanical thromboprophylaxis. So, Mechanical thromboprophylaxis was preferred over PTP in orthopedic patients. Case (3): An overweight teenager girl with Down syndrome on mechanical ventilation for pneumonia and receiving mechanical thromboprophylaxis, 46% of all respondents considered AC and only 34% of them would continue AC post-discharge. If she has been on oral contraceptive pills (OCPs), 68% would prescribe TPT. So, PTP in critically ill teenagers is equipoise even with overweight and immobilization. OCPs were perceived as important risk factor for VTE. Case (4): A child with ALL who had an acute stroke following induction chemotherapy including Asparginase, 82% of all respondents would consider AC for re-induction regimen containing Asparginase. So, PTP is recommended in children with ALL and Asparginase related strokes if re-exposed. Conclusions: The results of survey revealed that despite concerns about rising VTE prevalence, there is equipoise about the adoption of a universal PTP policy for children. Experts take into consideration multiple risk factors when deciding about primary thromboprophylaxis. The variability in clinical thromboprophylaxis practices highlights the need for rigorous prospective randomized trials so as to develop evidence-based VTE prevention strategies for children. Disclosures No relevant conflicts of interest to declare.

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