Epidemiology of Lower Extremity Deep Venous Thrombosis in Critically III Adolescents
Epidemiology of Lower Extremity Deep Venous Thrombosis in Critically III Adolescents
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DOI：
10.1016/j.jpeds.2018.05.006
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发表时间：
2018-10-01
影响因子：
5.1
通讯作者：
Silva, Cicero T.
中科院分区：
文献类型：
--
作者：
Faustino, Edward Vincent S.;Shabanova, Veronika;Silva, Cicero T.
目的了解危重青少年下肢深静脉血栓形成（DVT）的流行病学情况，目前尚不清楚。入住6个儿科重症监护室并预计接受心肺支持至少48小时的13-17岁青少年符合资格，除非他们因DVT或肺栓塞住院或正在接受或预计接受抗凝治疗。当患者在病房时，对下肢进行连续超声检查，然后进行集中裁定。贝叶斯统计被用来利用成人和青少年之间的相似性。结果共有88名青少年被招募，其中184下肢超声检查。这些。9例青少年发生DVT。其中1例为双侧DVT。DVT的发生率为12.4%（95%可信区间：6.1%，20.1%），范围为6.3%-19.8%，各单位的变异性为41.0%。所有DVT病例均发生在接受有创机械通气的青少年中（频率：16.5%; 95%可信区间8.1%）。26.6%）。DVT与股中心静脉置管（OR 15.44; 95%可信区间1.62，69.05）和严重疾病（死亡风险每增加0.1，OR 3.11; 95%可信区间1.19，6.85）相关。深静脉血栓形成似乎与延长天support.Conclusions我们的研究结果突出了成人和青少年之间的深静脉血栓形成的流行病学的相似性和差异。他们支持在危重青少年中进行药物预防试验，并为试验设计提供信息。
Objective To determine the epidemiology of lower extremity deep venous thrombosis (DVT) in critically ill adolescents, which currently is unclear.Study design We performed a multicenter, prospective, cohort study. Adolescents aged 13-17 years who were admitted to 6 pediatric intensive care units and were anticipated to receive cardiopulmonary support for at least 48 hours were eligible, unless they were admitted with DVT or pulmonary embolism or were receiving or anticipated to receive therapeutic anticoagulation. While patients were in the unit, serial sonograms of the lower extremities were performed, then centrally adjudicated. Bayesian statistics were used to leverage the similarities between adults and adolescents.Results A total of 88 adolescents were enrolled, from whom 184 lower extremity sonograms were performed. Of these. 9 adolescents developed DVT. with 1 having bilateral DVT. The frequency of DVT was 12.4% (95% credible interval: 6.1%, 20.1%), which ranged from 6.3% to 19.8% with a variability of 41.0% across units. All cases of DVT occurred in adolescents who received invasive mechanical ventilation (frequency: 16.5%; 95% credible interval 8.1%. 26.6%). DVT was associated with femoral central venous catheterization (OR 15.44; 95% credible interval 1.62, 69.05) and severe illness (OR for every 0.1 increase in risk of mortality 3.11; 95% credible interval 1.19, 6.85). DVT appears to be associated with prolonged days on support.Conclusions Our findings highlight the similarities and differences in the epidemiology of DVT between adults and adolescents. They support the conduct and inform the design of a trial of pharmacologic prophylaxis in critically ill adolescents.