DVT Prevention in Pediatric and Adolescent Trauma Patients: Safety and Costs

儿童和青少年创伤患者的 DVT 预防：安全性和成本

• 批准号: 7386804
• 负责人: SARAH H. OBRIEN
• 金额: $ 5.88万
• 依托单位: RESEARCH INST NATIONWIDE CHILDREN'S HOSP
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-30 至 2009-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7386804
• 关键词: DVT; Prevention; Pediatric; Adolescent; Trauma

DESCRIPTION (provided by applicant): Currently, the medical decision to provide deep venous thrombosis (DVT) prophylaxis to teenagers with multiple injuries may be based not on evidence, but on whether the ambulance transports them to an adult or pediatric trauma facility. In this proposal, we seek to identify which, if any, young trauma patients may truly benefit from the thromboprophylaxis strategies that have become standard of care in adults. The decision regarding who should receive thromboprophylaxis applies to a large number of patients, with >200,000 pediatric/adolescent trauma admissions every year. However, due to the relative rarity of DVT in young trauma patients, the question is difficult to study by traditional methods. The proposed research involves the construction of a decision analysis model to address the health effects and costs of thromboprophylaxis with low-molecular-weight heparin (LMWH) in pediatric and adolescent trauma patients. Decision analysis models require accurate, unbiased estimates of the various probabilities and outcomes that result from various choices. Currently, there is substantial uncertainty regarding several of the parameters necessary to construct such a model. Therefore, we will first analyze the National Trauma Data Bank, the largest aggregation of pediatric trauma registry data, to more clearly define the overall incidence and risk factors of DVT in young trauma patients, and to define the incidence of DVT in specific cohorts. Data collection on the incidence of major bleeding events with LMWH prophylaxis will take place through four major trauma centers. Finally, we will combine our data with the published literature on thromboembolism in pediatric trauma and construct a decision analysis model to estimate total costs of prevention, treatment, and outcomes of DVT in specific cohorts of pediatric trauma patients. The proposed research will provide clinicians with a tool to identify young trauma patients who would benefit from LMWH prophylaxis. The results will be used to create child and adolescent-specific guidelines, thereby allowing clinicians to maximize patient safety and minimize costs when considering LMWH prophylaxis for a young trauma patient.

描述（由申请人提供）：目前，向有多处伤害的青少年提供深层静脉血栓形成（DVT）预防的医疗决定可能不是基于证据，而是基于救护车是否将其运送到成人还是儿科创伤设施。在此提案中，我们寻求确定哪个（如果有的话）年轻的创伤患者可能会真正受益于已成为成年人标准护理的血栓预防策略。关于谁应该接受血栓预防的决定适用于大量患者，每年有> 20万儿科/青少年创伤。但是，由于年轻创伤患者的DVT相对罕见，因此很难通过传统方法研究这个问题。拟议的研究涉及建立一个决策分析模型，以解决小儿和青少年创伤患者中低分子量肝素（LMWH）的血栓预防效应和成本。决策分析模型需要对各种选择产生的各种概率和结果进行准确，公正的估计。当前，关于构建此类模型所需的几个参数存在很大的不确定性。因此，我们将首先分析国家创伤数据库，这是小儿创伤注册表数据的最大聚集，以更清楚地定义年轻创伤患者中DVT的总体发病率和危险因素，并确定特定队列中DVT的发生率。有关LMWH预防的重大出血事件发生率的数据收集将通过四个主要创伤中心进行。最后，我们将我们的数据与已发表的有关小儿创伤中血栓栓塞的文献结合在一起，并构建一个决策分析模型，以估计预防，治疗和DVT结果的总成本，在特定的小儿创伤患者中。拟议的研究将为临床医生提供一种工具，以识别将受益于LMWH预防的年轻创伤患者。结果将用于创建儿童和青少年特定的准则，从而允许临床医生在考虑年轻创伤患者的LMWH预防时最大化患者的安全性并最大程度地降低成本。