Infants and adolescents with complex chronic diseases are at risk for life-threatening blockages, regardless of whether they are treated at a community hospital or in a tertiary care setting. These are the findings from a Nationwide Children’s Hospital study meant to refine the epidemiologic understanding of acute and chronic diseases associated with pediatric venous thromboembolism.
Venous thromboembolism (VTE), which encompasses deep venous thrombosis and pulmonary embolism, is an important cause of morbidity and mortality in adults. VTE are considered to be relatively rare events in children. However, recent studies have shown that the incidence of VTE in children has been increasing over the last decade.
In a study appearing in Pediatric Blood & Cancer, investigators at Nationwide Children’s Hospital worked to provide a more comprehensive epidemiologic understanding of pediatric VTE association with acute and chronic diseases. Previously published data regarding VTE incidence in children was developed using databases that only include information from freestanding children’s hospitals. The study was also intended to assess for differences in VTE prevalence between children hospitalized in community hospitals versus children’s hospitals.
The team analyzed data from the Kids’ Inpatient Database 2006 project, which contains data from 38 state inpatient databases on children 20 years of age or younger who were discharged in 2006. The database included 2.4 million eligible discharges from public hospitals, academic medical centers and community and non-rehabilitation hospitals.
Similar to previous reports, the study showed that the majority of patients with VTE (77.7 percent) also had at least one complex chronic condition. VTE were most frequently associated with cardiovascular disease, followed by childhood cancer. Findings also suggest that patients with chronic neuromuscular diseases (brain and spinal cord malformations, infantile cerebral palsy, mental retardation, epilepsy and central nervous system degeneration) are the third largest group at risk for childhood VTE.
Despite the fact that the majority of the cases were reported from children’s hospitals, a quarter of VTE cases were from community hospitals (i.e. non-tertiary care settings.) Adolescents (ages 15 to 18) and neonates represented the majority of community VTE.
“This may reflect those VTEs occurring in community hospital neonatal units or in adolescents with acute conditions who present to community hospitals for initial care,” said Bryce A. Kerlin, MD, director of the Nationwide Children’s Hospital Hemostasis and Thrombosis Center, and principal investigator for the study.
Dr. Kerlin says that future pediatric VTE epidemiology research should focus on evaluating disease-specific VTE epidemiology in order to further refine the understanding of which children are at greatest risk.
Setty BA, O'Brien SH, Kerlin BA. Pediatric venous thromboembolism in the United States: A tertiary care complication of chronic diseases. Pediatr Blood Cancer. 2011 Oct 28. doi: 10.1002/pbc.23388. [Epub ahead of print]