1. Venous Thromboembolic (VTE) Prophylaxis in Pediatric Trauma Patients Bowe

2. Outline: Venous thromboembolism -- Adult population Venous thromboembolism -- Peds population Trauma population Chest guidelines

3. VTE: hospitalized adult population Geerts et al. Chest 2004

4. VTE: hospitalized adult population Risk Factors: -Central venous lines -Immobility -Malignancy -Major surgery -Medical illness -Sepsis -Trauma Complications: -Death -- 10% of all hospital deaths -Embolism -- PE, stroke -Clot burden/progression -- SVC syndrome -Recurrence -Post-thrombotic syndrome

5. VTE: pediatric population -Canadian Registry of Venous Thromboembolic Complications -- first analysis 1994

6. VTE: pediatric population Incidence: -Hospitalized population 5.3 per 10000 -General population 0.7 per 10000 * CVL associated w/20% of all VTEs

7. VTE: pediatric trauma -2001-2008 -260,078 pediatric trauma patients -- PHIS database -Age 0-18yrs -Identified those diagnosed with DVT or PE -Identified enoxaparin use via pharmacy codes

8. VTE: pediatric trauma Associated w/increased use of enoxaparin: -CVL -Pelvic or long bone fx -ICU length of stay -Level 1 trauma designation Associated w/increased VTE: -CVL -Pelvic fx -ICU length of stay

9. VTE: pediatric trauma

10. VTE: other populations -Central venous catheter use -Inflammatory bowel disease -Inherited coagulopathy -Malignancy -Orthopedic population

11. Sources: Andrew M, David M, Adams M, et al. Venous thromboembolic complications in children: first analyses of the Canadian Registry of VTE. Blood 1994; 83:1251-7. Askgard-Giesmann, O’Brien SH, Kenney BD. Increased use of enoxaparin in pediatric trauma patients. Journal of Pediatric Surgery 2012; 47:980-3 Azu MC, Lee TK. Venous thromboembolic events in pediatric trauma patients: is prophylaxis necessary? J Trauma 2005; 1345-9. David M, Andrew M. Venous thromboembolic complications in children. J Pediatr 1993; 123:337-46 Guy Y. New anticoagulants in children: A review of recent studies and a look to the future. Thrombosis research 2010; 70- 74. Moreno, PL. The ICU Book. Venous thromboembolism. 2007; 81-100. Truitt AK, Sorrells DL, Halvorson E, Luks FI, et al. Pulmonary embolism: which pediatric trauma patients are at risk? J Pediatr Surg 2005; 124-127. Vavilala MS, Nathens AB, Jurkovich GJ, et al. Risk factors for venous thromboembolism in pediatric trauma. J Trauma 2002;52:922-7.