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Incidence of venous thromboembolism in hospitalized pediatric neurosurgical patients: a retrospective 25-year institutional experience

  • Mason A. Brown
  • Daniel H. FulkersonEmail author
Original Article
  • 21 Downloads

Abstract

Purpose

Venous thromboembolism (VTE) refers to both deep venous thrombosis (DVT) and pulmonary embolism (PE). The risk of VTE in adult neurosurgical patients is thoroughly studied. However, the incidence and risk of VTE in a comprehensive pediatric neurosurgical population is not well-defined. The available pediatric data consists of reviews of specific high-risk groups, such as trauma, critical care, or cancer patients. This may not be reflective of the entire spectrum of a high-volume pediatric neurosurgery practice. This study was undertaken to analyze the incidence and risk factors of VTE in all hospitalizations evaluated by a pediatric neurosurgery service over a 25-year period.

Methods

A retrospective review of electronic medical records was performed for 9149 hospitalizations in 6374 unique patients evaluated by the pediatric neurosurgery service at Riley Hospital for Children (Indianapolis, IN, USA) from 1990–2014. During this time period, there was no standardized VTE prevention protocol. The study group included all patients less than 18 years of age. Patients with a known pre-existing VTE or pregnancy were excluded.

Results

VTE was diagnosed in 20 of the 9149 (0.22%) hospitalizations, in 18 unique patients. All DVTs were diagnosed via Doppler ultrasound and/or computed tomography. Anatomic clot locations included 9 in the upper extremity (0.098% of hospitalizations), 8 in the lower extremity (0.087%), and 4 (0.044%) pulmonary emboli. Ten of the 20 occurred in hospitalizations where the patient underwent surgery, although the need for surgery was not a statistically significant risk factor. Sixteen of the 20 (80%) occurred in patients with at least one form of central venous line (p < 0.00001). There was one VTE-related death (0.01%).

Conclusions

In all pediatric neurosurgical patients, a VTE was found in 0.22% of hospitalizations over a 25-year span. Statistically significant risk factors for VTE included central venous line placement, paralysis, malignancy, intubation greater than 48 h, and hypercoagulable state.

Keywords

Anticoagulation Deep vein thrombosis Neurological surgery Pediatrics Pulmonary embolism Thrombosis Thrombus Venous thromboembolism 

Abbreviations

VTE

Venous thromboembolism

PE

Pulmonary edema

DVT

Deep vein thrombosis

LMWH

Low molecular weight heparin

PICC

Peripherally inserted central catheter

Notes

Acknowledgments

We would like to thank the following people for data collection and organization: Kenneth Moore, MD; Benjamin K. Hendricks, MD; Katarzyna Kania, MD; Michael Tu, MD; Kareem Albaba, MD; Christian P. Gage, MD; Andrew Pavlina, MD; Zachary J. Plummer, MD; and Jacqueline M. Rees, MD.

Compliance with ethical standards

This study was conducted following Institutional Review Board approval and in accordance with university policy.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologyAurora St. Luke’s Medical CenterMilwaukeeUSA
  2. 2.Beacon Children’s Hospital, Beacon Medical Group North Central NeurosurgeryIndiana University School of MedicineSouth BendUSA

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