Effect of injury severity on the incidence and utilization-related outcomes of venous thromboembolism in pediatric trauma inpatients

Objective: The objective of this study was to generate national estimates of the effect of injury severity on the occurrence rate and associated resource utilization-related outcomes of venous thromboembolism (VTE) between pediatric and adolescent trauma inpatients in the United States. Data Source. 2003 Healthcare Cost and Utilization Project Kids' Inpatient Database, the largest all-payer pediatric (age <= 20 yrs) inpatient care database in the United States. Measurements and Main Results: VTE was identified in 2.7 per 1000 pediatric trauma discharges. Although injury severity is strongly associated with an increased risk of VTE, the occurrence rate is low even among critically injured patients (<2%). However, VTE has a significant and an independent impact on the length of stay and hospitalization costs in the critical care setting. Conclusions. VTE increases both the length of stay and hospitalization costs independent of injury severity, demonstrating the need to consider thromboprophylaxis in the critically injured population. However, the low overall occurrence rate of VTE in young trauma patients, even in the intensive care unit, highlights the need for additional studies of risk factors and the potential risks of prophylactic anticoagulation, so that thromboprophylaxis can be more directly targeted to the children at highest risk. (Pediatr Crit Care Med 2009; 10:554-557)