Authors: Mason Anthony Brown; Daniel Fulkerson, MD (Milwaukee, WI)
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, and multiple quality measures have been implemented to reduce the morbidity and mortality of this potentially preventable complication. However, the incidence and risk of VTE within a pediatric neurosurgical population is not well-defined. This study was undertaken to retrospectively analyze the incidence and specific risk factors of VTE in patients evaluated by a pediatric neurosurgery service over a 25-year period.
A retrospective review of electronic medical records was performed for 9149 hospitalizations (admissions or consultations) of 6355 unique patients evaluated by the pediatric neurosurgery service at Riley Hospital for Children (Indianapolis, IN) from 1990-2014. There were 6769 elective procedure admissions and 2380 trauma evaluations.
VTE was diagnosed in 19 (0.21%) hospitalizations in 18 (0.28%) unique patients. All DVTs were diagnosed via Doppler ultrasound and all PEs were identified via CT angiography. Anatomic clot locations included: 8 (0.09%) lower extremity DVT, 9 (0.10%) upper extremity DVT, and 3 (0.03%) PE. One (0.01%) patient developed a DVT and subsequent PE during the same admission, and 3 (0.03%) patients developed multiple DVTs during the same admission. Of the hospitalizations with VTE, 13 (68.42%) had some route of venous line placement prior to diagnosis.
A VTE was diagnosed in 19 of 9149 (0.21%) hospitalizations evaluated by a single-institution pediatric neurosurgical service over 25 years. This represents the experience of a broad, comprehensive pediatric neurosurgical population. Our data suggests that the risk of VTE in hospitalized pediatric patients is substantially lower than reported levels in adult neurosurgical patients.