Skip to main content
SpringerLink
Log in

Implementation of automatic data extraction from an enterprise database warehouse (EDW) for validating pediatric VTE decision rule: a prospective observational study in a critical care population

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

Multiple clinical risk prediction tools for hospital acquired venous thromboembolism (HA-VTE) have been developed. The objectives of this study were to develop and assess the feasibility of data extraction from Electronic Medical Records (EMR) from an enterprise database warehouse (EDW) and to test the validity of a previously developed Pediatric Clot Decision Rule (PCDR). This single-center prospective observational cohort study was conducted between March 2016 and March 2017 and included eligible patients admitted to the intensive care units. Risk score was calculated using the PCDR tool. Sensitivity, specificity, positive and negative predicted value (PPV and NPV) were calculated based on a cut‐point of 3. A total of 2822 children were eligible for analysis and 5.1% (95% CI 4.2–6.2) children had a PCDR score of 3. Children with PCDR score of ≥ 3 had a 3 times higher odd of developing VTE compared to those with scores < 3 (OR 3.1; 95% CI 1.93–4.80; p < 0.001). The model performance showed that at the cutoff point of ≥ 3, both the specificity and sensitivity of the PCDR in predicting VTE was 69% and NPV of 98%. We successfully demonstrated using our EDW to populate a research database using an automatic data import. A PCDR score of ≥ 3 was associated with VTE. Collaboration through large registries will be useful in informing practices and guidelines for rare disorders such as pediatric VTE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

HA-VTE:

Hospital acquired venous thromboembolism

EMR:

Electronic Medical Records

EDW:

Enterprise database warehouse

PCDR:

Pediatric Clot Decision rule

PPV:

Positive predictive values

NPV:

Negative predictive values

CVC:

Central venous catheters

SPS:

Children’s Hospitals Solutions for Patient Safety

ICU:

Intensive care unit

AUC:

Area under the curve

IT:

Information technology

CCPMS:

Computerized care process management system

PICU:

Pediatric intensive care unit

CICU:

Cardiac intensive care unit

NICU:

Neonatal Intensive care unit

SQL:

Structured Query Language

BMI:

Body mass index

CVC:

Central venous catheter

OCP:

Estrogen containing contraceptive pills

MV:

Mechanical ventilation

AUC:

Area under the receiver operating characteristics curve

ISTH:

International society of thrombosis and Haemostasis

CER:

Comparative effectiveness research

References

  1. Mahajerin A, Branchford BR, Amankwah EK, Raffini L, Chalmers E, van Ommen CH et al (2015) Hospital-associated venous thromboembolism in pediatrics: a systematic review and meta-analysis of risk factors and risk-assessment models. Haematologica 100(8):1045–1050

    PubMed  PubMed Central  Google Scholar 

  2. Takemoto CM, Sohi S, Desai K, Bharaj R, Khanna A, McFarland S et al (2014) Hospital-associated venous thromboembolism in children: incidence and clinical characteristics. J Pediatr 164(2):332–338

    Article  Google Scholar 

  3. Raffini L, Huang YS, Witmer C, Feudtner C (2009) Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007. Pediatrics 124(4):1001–1008

    Article  Google Scholar 

  4. Andrew M, David M, Adams M, Ali K, Anderson R, Barnard D et al (1994) Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood 83(5):1251–1257

    Article  CAS  Google Scholar 

  5. Chima RS, Hanson SJ (2017) Venous thromboembolism in critical illness and trauma: pediatric perspectives. Front Pediatr 5:47

    Article  Google Scholar 

  6. Hanson SJ, Punzalan RC, Greenup RA, Liu H, Sato TT, Havens PL (2010) Incidence and risk factors for venous thromboembolism in critically ill children after trauma. J Trauma 68(1):52–56

    Article  Google Scholar 

  7. Higgerson RA, Lawson KA, Christie LM, Brown AM, McArthur JA, Totapally BR et al (2011) Incidence and risk factors associated with venous thrombotic events in pediatric intensive care unit patients. Pediatr Crit Care Med 12(6):628–634

    Article  Google Scholar 

  8. Landisch RM, Hanson SJ, Punzalan RC, Braun K, Cassidy LD, Gourlay DM (2018) Efficacy of surveillance ultrasound for venous thromboembolism diagnosis in critically ill children after trauma. J Pediatr Surg 53(11):2195–2201

    Article  Google Scholar 

  9. Sandoval JA, Sheehan MP, Stonerock CE, Shafique S, Rescorla FJ, Dalsing MC (2008) Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: an increasing population at risk. J Vasc Surg 47(4):837–843

    Article  Google Scholar 

  10. Setty BA, O'Brien SH, Kerlin BA (2012) Pediatric venous thromboembolism in the United States: a tertiary care complication of chronic diseases. Pediatr Blood Cancer 59(2):258–264

    Article  Google Scholar 

  11. Ye F, Stalvey C, Khuddus MA, Winchester DE, Toklu HZ, Mazza JJ et al (2017) A systematic review of mobility/immobility in thromboembolism risk assessment models for hospitalized patients. J Thromb Thrombolysis 44(1):94–103

    Article  Google Scholar 

  12. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133(6 suppl):38s1–453s

    Article  Google Scholar 

  13. Badawy SM, Rychlik K, Sharathkumar AA (2016) Current practice of pharmacological thromboprophylaxis for prevention of venous thromboembolism in hospitalized children: a survey of pediatric hemostasis and thrombosis experts in North America. J Pediatr Hematol Oncol 38(4):301–307

    Article  CAS  Google Scholar 

  14. Arlikar SJ, Atchison CM, Amankwah EK, Ayala IA, Barrett LA, Branchford BR et al (2015) Development of a new risk score for hospital-associated venous thromboembolism in critically-ill children not undergoing cardiothoracic surgery. Thromb Res 136(4):717–722

    Article  CAS  Google Scholar 

  15. Atchison CM, Arlikar S, Amankwah E, Ayala I, Barrett L, Branchford BR et al (2014) Development of a new risk score for hospital-associated venous thromboembolism in noncritically ill children: findings from a large single-institutional case-control study. J Pediatr 165(4):793–798

    Article  Google Scholar 

  16. Mahajerin A, Webber EC, Morris J, Taylor K, Saysana M (2015) Development and implementation results of a venous thromboembolism prophylaxis guideline in a tertiary care pediatric hospital. Hosp Pediatr 5(12):630–636

    Article  Google Scholar 

  17. Prentiss AS (2012) Early recognition of pediatric venous thromboembolism: a risk-assessment tool. Am J Crit Care 21(3):178–83

    Article  Google Scholar 

  18. Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L et al (1997) Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 350(9094):1795–1798

    Article  CAS  Google Scholar 

  19. Sharathkumar AA, Mahajerin A, Heidt L, Doerfer K, Heiny M, Vik T et al (2012) Risk-prediction tool for identifying hospitalized children with a predisposition for development of venous thromboembolism: Peds-Clot Clinical Decision Rule. J Thromb Haemost 10(7):1326–1334

    Article  CAS  Google Scholar 

  20. Schultz R, Kwon S, Sharathkumar A, Bhat R. Validation of the Peds Clot Clinical Decision Rule [PCDR] in Hospital-Acquired Venous Thromboembolism. Blood. 2017(130).

  21. Schultz RF, Kwon K, Sharathkumar A, Bhat R (2016) Prospective validation of the Peds Clot Clinical Decision Rule [Pdcr] in hospital-acquired venous thromboembolism: an interim analysis. Blood 128:3812

    Article  Google Scholar 

  22. Brundin-Mather R, Soo A, Zuege DJ, Niven DJ, Fiest K, Doig CJ et al (2018) Secondary EMR data for quality improvement and research: a comparison of manual and electronic data collection from an integrated critical care electronic medical record system. J Crit Care 47:295–301

    Article  Google Scholar 

  23. Krasowski MD, Schriever A, Mathur G, Blau JL, Stauffer SL, Ford BA (2015) Use of a data warehouse at an academic medical center for clinical pathology quality improvement, education, and research. J Pathol Inform 6:45

    Article  Google Scholar 

  24. VanderWeele J, Pollack T, Oakes DJ, Smyrniotis C, Illuri V, Vellanki P et al (2018) Validation of data from electronic data warehouse in diabetic ketoacidosis: caution is needed. J Diabetes Complicat 32(7):650–654

    Article  Google Scholar 

  25. Branchford BR, Gibson E, Manco-Johnson MJ, Goldenberg NA (2012) Sensitivity of discharge diagnosis ICD-9 codes for pediatric venous thromboembolism is greater than specificity, but still suboptimal for surveillance and clinical research. Thromb Res 129(5):662–663

    Article  CAS  Google Scholar 

  26. Loong TW (2003) Understanding sensitivity and specificity with the right side of the brain. BMJ 327(7417):716–719

    Article  Google Scholar 

  27. Manco-Johnson MJ, Grabowski EF, Hellgreen M, Kemahli AS, Massicotte MP, Muntean W et al (2002) Laboratory testing for thrombophilia in pediatric patients. On behalf of the Subcommittee for Perinatal and Pediatric Thrombosis of the Scientific and Standardization Committee of the International Society of Thrombosis and Haemostasis (ISTH). Thromb Haemost. 88(1):155–6

    Article  CAS  Google Scholar 

  28. Chalmers EA (2006) Epidemiology of venous thromboembolism in neonates and children. Thromb Res 118(1):3–12

    Article  CAS  Google Scholar 

  29. Stein PD, Kayali F, Olson RE (2004) Incidence of venous thromboembolism in infants and children: data from the National Hospital Discharge Survey. J Pediatr 145(4):563–565

    Article  Google Scholar 

  30. van Ommen CH, Heijboer H, Buller HR, Hirasing RA, Heijmans HS, Peters M (2001) Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands. J Pediatr 139(5):676–681

    Article  Google Scholar 

  31. Mahajerin A, Jaffray J, Branchford B, Stillings A, Krava E, Young G et al (2020) Comparative validation study of risk assessment models for pediatric hospital-acquired venous thromboembolism. J Thromb Haemost 18(3):633–641

    Article  Google Scholar 

  32. Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J et al (2003) Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 349(13):1227–1235

    Article  CAS  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Division of Obstetrics, Stony Brook University Hospital, Stony Brook, NY, USA

    Rachael F. Schultz

  2. Division of Hematology/Oncology, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa, USA

    Anjali Sharathkumar

  3. Stanley Manne Children’s Research Institute, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Soyang Kwon

  4. Milwaukee, WI, USA

    Karl Doerfer

  5. Department of Data Analytics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    George Lales

  6. Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Box 30, Chicago, IL, 60611, USA

    Rukhmi Bhat

Authors
  1. Rachael F. Schultz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anjali Sharathkumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Soyang Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karl Doerfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. George Lales
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rukhmi Bhat
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RS: Collected data for Phase III part of the study, data analysis, drafted and revised manuscript. AS: Conceived the research design and developed the research database, drafted and revised the manuscript. SKW: Performed data-analyses, drafted and revised the manuscript. KD: Developed the code for data export code, developed research database and revised manuscript. GL: Built research database and approved manuscript. RB: Supervised data quality, conduct of research, data analysis and drafted and revised manuscript. All authors made contributions to the study conception and design, drafted or revised it critically for important intellectual content and approved final version of the manuscript.

Corresponding author

Correspondence to Rukhmi Bhat.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The paper has been published as a meeting abstract in the following meetings listed below: (1) Prospective Validation of the Peds Clot Clinical Decision Rule [Pcdr] in Hospital-Acquired Venous Thromboembolism: An Interim Analysis. American Society of Hematology 2016. Schultz RF, Kwon K, Sharathkumar A, Bhat R. Blood. 2016; 128. (2) Validation of the Peds Clot Clinical Decision Rule [PCDR] in Hospital-Acquired Venous Thromboembolism. American Society of Hematology 2017. Schultz R, Kwon S, Sharathkumar A, Bhat R. Blood. 2017; 130.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 121 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schultz, R.F., Sharathkumar, A., Kwon, S. et al. Implementation of automatic data extraction from an enterprise database warehouse (EDW) for validating pediatric VTE decision rule: a prospective observational study in a critical care population. J Thromb Thrombolysis 50, 782–789 (2020). https://doi.org/10.1007/s11239-020-02158-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-020-02158-9

Keywords

Search

Navigation