Robert Murray, MD
Pediatric Critical Care Fellow
n/a
Columbus, Ohio
Disclosure information not submitted.
Jennifer Muszynski, MD, FCCM
Associate Professor of Pediatrics
Nationwide Children's Hospital At Ohio State University, United States
Disclosure information not submitted.
Colleen Cloyd, PharmD, BCPPS
Advanced Patient Care Pharmacist
Nationwide Children's Hospital
Columbus, Ohio
Disclosure information not submitted.
Brittany Palmer, RN
RN Clinical Leader
Nationwide Childrens Hospital, United States
Disclosure information not submitted.
Vilmarie Rodriguez, MD
Physician, Hematology
Nationwide Childrens Hospital, United States
Disclosure information not submitted.
Title: Pediatric Venous-Thromboembolism Prevention: Baseline data for a PICU Quality Improvement Initiative
Introduction: Venous-thromboembolism (VTE) occurs frequently in critically ill children. Up to 25% with a history of limb related VTE will develop post-thrombotic syndrome, while up to 20% can develop a pulmonary embolus with a mortality rate of between 2-9%. Provision of VTE prophylaxis for critically ill children is highly variable. In preparation for a quality improvement initiative to improve the rate of appropriate VTE prophylaxis in critically ill children, we sought to identify the baseline rate of VTE prophylaxis in our pediatric intensive care unit (PICU).
Methods: A VTE prevention guideline was created by a multidisciplinary working group, adapted from published VTE risk assessment tools. Patients are risk stratified for the development of VTE and bleeding risk. To determine baseline provision of appropriate VTE prophylaxis this guideline was retrospectively applied to randomly selected patients aged 1-18 years admitted to the PICU from December 2020-April 2021. Children with COVID/MIS-C, trauma, ECMO or those receiving therapeutic anticoagulation were excluded. Appropriate VTE prophylaxis was defined as pharmacologic prophylaxis (PP) +/- mechanical prophylaxis (MP) for patients with high risk for VTE and with no or low bleeding risk factors; MP for patients with high risk for VTE and bleeding risk factors or for patients with moderate VTE risk.
Results: A total of 78 PICU admissions, with a mean age of 10.6 years were reviewed. Of these, 52% did not have VTE prophylaxis, 42% received MP alone, 5% received combined MP and PP, and 1% received PP alone. Based on our VTE prevention guideline only 64% of patients received appropriate prophylaxis based on their risk stratification. Children older than 12 years of age were more likely to receive any kind of prophylaxis compared to children younger than 12 years of age (94% vs 9%).
Conclusions: VTE prophylaxis was provided less often than indicated to our critically ill pediatric patients. Barriers include low utilization of PP when clinically appropriate, difficulties in providing MP to younger children and no defined process to identify VTE risk stratification. PDSA cycles have begun with the aim to provide clinically appropriate VTE prophylaxis to 85% of PICU patients.