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.
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Hospital acquired venous thromboembolism
Electronic Medical Records
Enterprise database warehouse
Pediatric Clot Decision rule
Positive predictive values
Negative predictive values
Central venous catheters
Children’s Hospitals Solutions for Patient Safety
Intensive care unit
Area under the curve
Computerized care process management system
Pediatric intensive care unit
Cardiac intensive care unit
Neonatal Intensive care unit
Structured Query Language
Body mass index
Central venous catheter
Estrogen containing contraceptive pills
Area under the receiver operating characteristics curve
International society of thrombosis and Haemostasis
Comparative effectiveness research
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
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
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
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
Chima RS, Hanson SJ (2017) Venous thromboembolism in critical illness and trauma: pediatric perspectives. Front Pediatr 5:47
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
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
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
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
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
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
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
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
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
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
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
Prentiss AS (2012) Early recognition of pediatric venous thromboembolism: a risk-assessment tool. Am J Crit Care 21(3):178–83
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
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
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).
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
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
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
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
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
Loong TW (2003) Understanding sensitivity and specificity with the right side of the brain. BMJ 327(7417):716–719
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
Chalmers EA (2006) Epidemiology of venous thromboembolism in neonates and children. Thromb Res 118(1):3–12
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
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
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
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
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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.
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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 (2020). https://doi.org/10.1007/s11239-020-02158-9
- Venous thromboembolism
- Enterprise database warehouse
- Medical record linkage
- Critical care
- Information technology