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

描述（由申请人提供）：目前，为多处受伤的青少年提供深静脉血栓形成（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他们运送到成人或儿童创伤设施。在这个建议中，我们试图确定，如果有的话，年轻的创伤患者可能真正受益于血栓预防策略，这已经成为成人护理的标准。关于谁应该接受血栓预防的决定适用于大量患者，每年有100万儿童/青少年创伤入院。然而，由于年轻创伤患者中DVT的相对罕见，这一问题很难用传统的方法来研究。本研究拟建立一个决策分析模型，以解决儿童和青少年创伤患者使用低分子肝素（LMWH）预防血栓的健康影响和成本。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、无偏的估计。目前，关于构建这种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，这是最大的儿科创伤注册数据集合，以更清楚地定义年轻创伤患者DVT的总体发病率和危险因素，并定义特定队列的DVT发病率。关于低分子肝素预防的大出血事件发生率的数据收集将通过四个主要的创伤中心进行。最后，我们将把我们的数据与已发表的关于儿科创伤血栓栓塞的文献结合起来，构建一个决策分析模型，以估计儿科创伤患者特定队列中DVT的预防、治疗和结局的总成本。拟议的研究将为临床医生提供一种工具，以确定将受益于低分子肝素预防的年轻创伤患者。研究结果将用于制定针对儿童和青少年的指南，从而使临床医生在考虑对年轻创伤患者进行低分子肝素预防时，能够最大限度地提高患者的安全性，并最大限度地降低成本。

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.