Pablo Napky Raudales, MD
Pediatric Resident
Nicklaus Children's Hospital
Miami, Florida
Disclosure information not submitted.
Rodrigo Cavalcante, MD
Resident
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Prithvi Raj Sendi, MD
Nicklaus Children's Hospital
Miami, Florida
Disclosure information not submitted.
Paul Martinez, MD
Assistant Professor
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Balagangadhar Totapally, MBBS, MD, DCH, MRCP, FAAP, FCCP, FCCM
Chief, Division of Critical Care Medicine. Program Director, Critical Care Fellowship Program
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Title: Epidemiology and Outcomes of intracardiac thrombosis in children.
Introduction: Intracardiac thrombosis is a rare diagnosis of unknown incidence in the pediatric population. The goal of this study was to describe national demographics, risk factors, and outcomes associated with intracardiac thrombosis in the pediatric population.
Methods: A retrospective analysis of the Healthcare Cost and Utilization Project’s 2016 Kids’ Inpatient Database was performed. Patients, birth to 21 years of age, were identified using the ICD-10 code I51.3 for intracardiac thrombosis. Univariate and multivariable regression analyses were used to analyze data. Inferential statistics are as odds ratio with 95% CI. Continuous variables are presented as medians with interquartile range (IQR). P < 0.05 is considered significant.
Results: We identified a total of 584 patients with intracardiac thrombosis among 6,266,287 discharges in 2016 (0.9 cases/10,000 discharges). The majority of the patients with intracardiac thrombosis were male (60.8%), white (47.8%), non-neonate (79.9%), had government insurance (49.9%) and were admitted at teaching hospitals (96.2%). Median age was 9 years (IQR 0-17), median length of stay was 10 days (IQR 2-28) and median total charges were $119,648 (IQR 40,027-431,896). Complications of intracardiac thrombosis include, acute stroke (6.2%), pulmonary embolism (5%), arterial embolism (1.7%). The case fatality rate with a diagnosis of intracardiac thrombosis was 6.8%. Multivariable regression demonstrated malignancies (OR:14.9, 95%CI:12.3-18.0) congenital heart disease or valvulopathy (OR:9.7, 95%CI:8.0-11.8), deep vein thrombosis or congenital thrombophilia (OR:5.7, 95%CI:4.5-7.3), heart failure or arrythmias (OR:4.5, 95%CI: 3.7-5.6), cardiac surgery procedure (OR:3.4, 95%CI:2.6-4.5), inflammatory bowel disease (OR:2.6, 95%CI: 2.0-3.4), and sepsis (OR:1.9, 95%CI:1.4-2.6) to be common associations with intracardiac thrombosis.
Conclusion: Intracardiac thrombosis is an uncommon diagnosis in children which carries a high mortality. Risk factors associated with a diagnosis of intracardiac thrombosis include malignancy, congenital heart disease, the presence of deep vein thrombosis, heart failure, cardiac surgery, inflammatory bowel disease, or sepsis.