O2088: Venous Thromboembolism Risk Assessment and Thromboprophylaxis in Hospitalized Pediatric Patients

Background: The approach to risk assessment of venous thromboembolism (VTE) in hospitalized pediatric patients is widely varied among medical institutions. Despite objective data supporting the need for protocolized thromboprophylaxis in children’s hospitals, publications suggest that 32-63% of institutions have formal protocols in place. The goal of this study was to gain an objective understanding of the interinstitutional variability in pediatric VTE risk assessment.

Methods: This study was conducted via RedCap survey and distributed to pediatric critical care and hospital medicine providers across the United States via email, phone call, and social media posts. Survey responses were collected from 12/2023 to 2/2024.

Results: A total of 52 survey responses were received, representing 48 hospitals across 31 states. 52% of survey respondents reported their institution had a formal protocol in place, with protocols in place on average for 5.6 years (95% CI = 3.80, 7.46).

A total of 16 unique protocols were received, with equal distribution between the Northeast, Midwest, South, and Western United States. Most protocols did not specify which provider is responsible for performing VTE screening (31%) and how often to repeat the screening (50%). Repeat screenings, when recommended, were advised between every 24 hours to every 4 days.

All protocols listed specific risk factors leading to increased risk for VTE, but there was significant variability in risk factors listed. In 88% of protocols, age was included as a risk factor, with patients above age 11.5 years (95% CI = 10.72, 12.70) to be considered high risk. No protocol distinguished patient sex as a risk factor. 75% of protocols included obesity as a risk factor. Personal history of DVT/VTE was identified in 63%, and 69% identified 1st degree family member with VTE as a risk factor. 63% identified thrombophilia as a risk factor. 81% of protocols included a decrease in mobility (≥48 hours) as a risk factor, though of these, just 23% identified an objective measurement for mobility, most commonly the Braden Q Scale. There was also marked variability between protocols in identifying disease processes, traumatic injuries, and cardiac conditions leading to hypercoagulability.

Among protocols which specified methods for thromboprophylaxis, early ambulation was recommended for “low risk” patients (86%), mechanical prophylaxis for “moderate risk” patients (86%), and both mechanical and chemical prophylaxis for “high risk” patients (71%). The preferred methods for mechanical and chemical prophylaxis were intermittent pneumatic compression (IPC) (100%, 13% of which recommended either IPC or graduated compression stockings) and enoxaparin (92%, 50% of which recommended either enoxaparin or unfractionated heparin), respectively.

Conclusion: Overall, our data suggests interinstitutional variability in identifying patients at greatest risk for VTE formation while having more similarity in prophylaxis methods. This supports the need for standardization of care in the risk assessment of VTE in hospitalized children.