A multi-institutional registry of pediatric hospital-acquired thrombosis cases: The Children's Hospital-Acquired Thrombosis (CHAT) project
A multi-institutional registry of pediatric hospital-acquired thrombosis cases: The Children's Hospital-Acquired Thrombosis (CHAT) project
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DOI：
10.1016/j.thromres.2017.11.019
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发表时间：
2018-01-01
影响因子：
7.5
通讯作者：
Branchford, Brian
中科院分区：
文献类型：
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作者：
Jaffray, Julie;Mahajerin, Arash;Branchford, Brian
背景：儿科医院获得性静脉血栓栓塞（HA-VTE）发生率急剧上升。为了在HA-VTE风险因素和风险预测模型的推导和验证中获得可推广的知识，并为未来的风险分层预防策略提供信息，需要多机构研究。目的：本文介绍了一项由研究者发起的多中心儿科病例队列研究，旨在确定HA-VTE的危险因素，建立HA-VTE风险预测模型。方法：为儿童医院获得性血栓形成（CHAT）研究创建了一个注册表，其中包含来自HA-VTE受试者和非HA-VTE对照的相关变量。将使用多变量回归识别与HA-VTE风险相关的注册表中的特定变量，以创建儿科HA-VTE风险预测模型并进行前瞻性验证。结果：七家大型儿科机构已将600多名年龄在0-21岁的HA-VTE受试者登记入册。受试者以男性为主（57%），中位年龄为3岁（IQR为0.3-13），在静脉血栓栓塞诊断时最可能住进重症监护病房（57%）。到HA-VTE的中位时间为入院后10天。最常见的危险因素包括中心静脉导管（80%）、手术（43%）、全身性类固醇（31%）、先天性心脏病（27%）、感染（14%）和癌症（13%）。结论：CHAT建立了一个风险预测模型，并使用CHAT注册表进行前瞻性验证，这是一项新颖的研究设计，通过帮助确定初始或更积极的血栓预防工作的最高风险人群，将是确定安全有效的策略以降低儿童HA-VTE的第一步。
Background: Pediatric hospital-acquired venous thromboembolism (HA-VTE) rates have increased dramatically. To achieve generalizable knowledge in the derivation and validation of HA-VTE risk factors and risk prediction models and inform future risk-stratified prevention strategies, multi-institutional studies are needed.Objectives: This paper presents an investigator-initiated, multicenter pediatric case-cohort study designed to identify risk factors for HA-VTE to create a HA-VTE risk prediction model.Methods: A registry, which houses pertinent variables from HA-VTE subjects and non-HA-VTE controls, was created for the Children's Hospital-Acquired Thrombosis (CHAT) study. Specific variables from the registry associated with HA-VTE risk will be identified using multivariable regression to create a pediatric HA-VTE risk prediction model to be prospectively validated.Results: Seven large pediatric institutions have entered over 600 HA-VTE subjects aged 0-21 years of age into the registry. Subjects showed a male predominance (57%), a median age of three years (IQR 0.3-13) and were most likely admitted to an intensive care unit (57%) at VTE diagnosis. Median time to HA-VTE was 10 days after admission. The most prevalent risk factors include central venous catheters (80%), surgery (43%), systemic steroids (31%), congenital heart disease (27%), infection (14%) and cancer (13%).Conclusions: CHAT, with its creation of a risk prediction model with prospective validation using the CHAT registry, is a novel study design and will be the first step in identifying safe and effective strategies to decrease HA-VTE in children by helping define the highest risk population for initial, or more aggressive, thromboprophylaxis efforts.