HOSPITAL-ACQUIRED VENOUS THROMBOEMBOLISM AMONG ADULTS ADMITTED TO A CHILDREN’S HOSPITAL

Stephanie Royer, MD1, Alicia Caldwell, MD1, Brian Herbst, MD1, Ashley Jenkins, MD1, Benjamin Kinnear, MD1, Matthew Kelleher, MD1, Lilliam Ambroggio, PhD2, Lori Herbst, MD1, Ranjit Chima, MD2, Jennifer O'Toole, MD3, 1Cincinnati Children's Hospital Medical Center/University of Cincinnati Medical Center, Cincinnati, OH; 2Cincinnati Children's Hospital Medical Center; 3Cincinnati Children's Hospital Medical Center/University of Cincinnati Medical Center, CINCINNATI, OH

Meeting: Hospital Medicine 2018; April 8-11; Orlando, Fla.

Abstract number: 330

Categories: Hospital Medicine 2018, Research, Transitions of Care

Keywords: ,

Background: Risk factors for hospital-acquired venous thromboembolism (HA-VTE) have been well-studied in adults, with validated risk assessment tools available. Adults admitted to children’s hospitals are younger but with comorbidities stemming from childhood conditions. There is a paucity of data on HA-VTE characteristics and risk factors in this population. Our objective was to evaluate HA-VTE in adult-aged (≥18 years) patients admitted to Cincinnati Children’s Hospital Medical Center.

Methods: We performed a single center case-control study encompassing a 4 year period (2013-2016). Cases of HA-VTE were defined as radiographic evidence of deep vein thrombosis (DVT) or pulmonary embolism (PE) that developed ≥48 hours after admission or within 30 days of hospital discharge. Controls were matched 2:1 on age and date of admission. Six reviewers abstracted data including patient characteristics, co-morbidities, VTE risk scores (Caprini and Padua), VTE characteristics, and outcomes. Wilcoxon-rank sum test was used for continuous variables and chi-squared or fisher exact tests were used for categorical variables. Conditional logistic regression was done to estimate the association of Caprini and Padua score with HA-VTE.

Results: Over the study period we identified 27 cases of HA-VTE, and 54 appropriate controls. 88.9% of events were DVTs and 11.1% were PEs. Patient characteristics and HA-VTE risk factors are presented in Table 1. Cases and controls had similar co-morbidities, except for malignancy, which was significantly higher in cases. The Caprini score on admission was significantly higher in cases than controls (p<0.01); the Padua scores were similar (p=0.1). As the Caprini score increased, odds of developing HA-VTE progressively increased (OR 0.96 95% CI 0.1-10.4 for 1-2 vs 0; OR 7.9 95% CI 0.8-78.9 for 5+ vs 0). Higher Padua score (≥4 vs <4) was also associated with increased odds of HA-VTE (OR 2.2 95% CI 0.8-5.8). These results did not reach statistical significance owing to small sample size. Pharmacologic and/or mechanical prophylaxis was given in 30% of cases and 28% of controls (p=0.86). In-hospital mortality was significantly higher in cases.

Conclusions: In this single center study, malignancy, critical illness, presence of central venous catheter, 30-day readmission, and longer length of stay were significant risk factors for HA-VTE in adults admitted to a children’s hospital. HA-VTE was associated with increased mortality. The Caprini score performed better than Padua at identifying patients at higher risk of clot, although with a small sample size there may be confounders which were not accounted for in the analysis. Future directions should include a multi-institutional study to determine if these results are more broadly applicable.

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To cite this abstract:

Royer, S; Caldwell, A; Herbst, B; Jenkins, A; Kinnear, B; Kelleher, M; Ambroggio, L; Herbst, L; Chima, R; O'Toole, JK. HOSPITAL-ACQUIRED VENOUS THROMBOEMBOLISM AMONG ADULTS ADMITTED TO A CHILDREN’S HOSPITAL. Abstract published at Hospital Medicine 2018; April 8-11; Orlando, Fla. Abstract 330. https://www.shmabstracts.com/abstract/hospital-acquired-venous-thromboembolism-among-adults-admitted-to-a-childrens-hospital/. Accessed November 14, 2019.

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